Adverse Local Tissue Reaction Associated With a Modular Hip Hemiarthroplasty

Whitehouse, Michael R; Endo, Makoto; Masri, Bassam A.

doi:10.1007/s11999-013-3133-1

Cited by 50 publications

(40 citation statements)

References 19 publications

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“…With pseudotumour formation and development of an inflammatory response, significant soft tissue damage can ensue. ALTR is most commonly described in MoM THR but also occurs in MoP THR 4,5,10,11 and even modular hemiarthroplasty 19 . The presented series describes significant ALTR and secondary pseudotumour formation in a cohort of MoP THR patients.…”

Section: Discussionmentioning

confidence: 99%

Delayed dislocation following metal-on-polyethylene arthroplasty of the hip due to ‘silent’ trunnion corrosion

Lash

Whitehouse

Greidanus

et al. 2016

The Bone & Joint Journal

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We present a case series of metal on polyethylene total hip replacement (MoP THR) with delayed onset dislocation, associated with unrecognised adverse local tissue reaction to trunnion corrosion and pseudotumour formation. The diagnosis was not suspected in nine of the ten cases, despite the subspecialty nature of the unit at which they were treated. Instead, it was identified at the time of revision surgery, because of the intraoperative findings, subsequently confirmed by histological examination of the resected tissue. Preoperative assessment and culture results ruled out infection.A variety of treatment strategies were employed, including tumour resection and efforts to avoid recurrent dislocation. The rate of complications was high and included three deep infections, two cases with recurrent dislocation, and one recurrent pseudotumour. This series demonstrates that pseudotumour is an infrequent but important cause of delayed instability following MoP THR, and it is easy to overlook in the differential diagnosis, especially if the original implant alignment is less than optimal, leading to an assumption of component malalignment as the cause of the dislocation.Revision is complex, requiring resection of the pseudotumour and modification of the reconstruction. The risk of postoperative complication is high.

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Section: Discussionmentioning

confidence: 99%

Delayed dislocation following metal-on-polyethylene arthroplasty of the hip due to ‘silent’ trunnion corrosion

Lash

Whitehouse

Greidanus

et al. 2016

The Bone & Joint Journal

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“…First, by confining our review to studies that included quantitative or semiquantitative grading of the histologic findings, we excluded many publications that have used only qualitative descriptions of periarticular findings [5,12,29,35,42,44,46] or that have focused on particle quantitation [13,30,45], cytokine detection [9,21], or lymphocyte subsets [29]. Among the studies that have graded morphologic features of periprosthetic tissues, many have not included conventional metal-on-PE or ceramic-on-polyethylene cases as controls, and differences in grading criteria among studies preclude pooling the data into larger groups.…”

Section: Discussionmentioning

confidence: 99%

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

Bauer

Campbell

Hallerberg

2014

Clin Orthop Relat Res

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Background The biologic reactions to byproducts of wear or corrosion can involve innate and adaptive processes and are dependent on many factors, including the composition, size, surface properties, shape, and concentration of debris. Questions/purposes We used a systematic literature review to compare the reported patterns of inflammation in tissues around total hip implants with the goal of identifying whether there are unique or characteristic patterns associated with the newer bearing options or modular components. Methods A search of the Ovid Medline database between 1996 and early December 2013 identified articles that compared the histology around six implant groups: (1) metal-on-metal; (2) ceramic-on-ceramic; (3) metalon-crosslinked polyethylene; (4) metal-on-conventional polyethylene with or (5) without modularity; and (6) tissue obtained at primary arthroplasty. Our initial search yielded 865 citations. After excluding articles that lacked a quantitative or semiquantitative description of histologic findings in periprosthetic tissue, we reviewed 34 articles. Results No pattern of inflammation is specific for any given bearing combination. Histologic features suggestive of an adaptive immune response appear to be more frequent and of greater magnitude in failed metal-on-metal implants, but tissues around many failed metal-on-metal implants show features of an ''innate'' foreign body reaction without lymphocytes. Occasional nonmetal-on-metal implants show features of an immune reaction, possibly associated with metal particles. Modular connections are one source of metal debris in nonmetal-on-metal implants. Features of an immune reaction appear rare in ceramicon-ceramic implants that lack corrosion. Insufficient reports are available to characterize the biologic response to crosslinked polyethylene.

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“…Two of the final articles were removed because they addressed corrosion secondary to stem loosening and a knee modular revision component. This left nine articles focused on corrosion in femoral hip components [9,10,23,29,32,37,42,46,47].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…There were nine studies identified addressing the surgical treatment of implant failures secondary to taper corrosion (Table 5) [9,10,23,29,32,37,42,46,47]. Eight articles were case report studies and one was Level IV.…”

Section: Treatment Of Corrosionmentioning

confidence: 99%

“…While corrosion of modular junctions is not a new finding, its contribution to failed arthroplasties seems to be on the rise. Multiple theories have been proposed for the apparent increase, including increased use of larger-diameter heads, modular adaptors with the larger heads, smaller and shorter tapers, poor assembly, and component metallurgy issues [9,10,23,29,42,47]. In each instance, the underlying process leading to corrosion appears to be mechanically assisted crevice corrosion generating particulate debris.…”

Section: Introductionmentioning

confidence: 99%

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The Surgical Options and Clinical Evidence for Treatment of Wear or Corrosion Occurring With THA or TKA

Engh

Padgett

2014

Clin Orthop Relat Res

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Background Wear and corrosion occurring in patients with hip and knee arthroplasty are common causes of failure leading to revision surgery. A variety of surgical approaches to these problems have been described, with varying efficacy. Polyethylene wear, metal-on-metal (MoM) hip bearing wear, and problems associated with modular taper corrosion are the areas of greatest clinical impact; results of revisions for these problems are likely to dictate a large portion of revision resources for the foreseeable future, and so they call for specific study. Questions/purposes We identified the most frequently reported procedures to treat hip polyethylene wear, knee polyethylene wear, MoM wear after THA, and modular taper corrosion and determined the timing and reasons these failed. Methods We performed systematic reviews of the published literature on the four topics using MEDLINE 1 and Embase in October 2013; searches were supplemented by hand searches of bibliographies. Prespecified criteria resulted in the identification of 38 relevant articles, of which 33 were either case reports or Level IV evidence. Followup was generally at short term and ranged from 0.2 to 8 years. Results The most frequently reported procedures for treating clinically important wear were a partial or complete revision. When treating polyethylene wear, the more frequently reported reasons for hip and knee rerevisions were loosening, continued wear, and instability. Soft tissue reactions were more common and occasionally extensive in patients with MoM or modular taper corrosion. Patients with soft tissue reactions had more complications and higher rerevision rates. Conclusions Studies with longer followup and higher levels of evidence are needed to direct the treatment of wear and corrosion. When soft tissue damage secondary to MoM wear or taper corrosion is present, the results of treatment can be poor. There is an urgent need to better understand these two mechanisms of failure.

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Adverse Local Tissue Reaction Associated With a Modular Hip Hemiarthroplasty

Abstract: Background The local and systemic effects of wear

Cited by 50 publications

References 19 publications

Delayed dislocation following metal-on-polyethylene arthroplasty of the hip due to ‘silent’ trunnion corrosion

Delayed dislocation following metal-on-polyethylene arthroplasty of the hip due to ‘silent’ trunnion corrosion

How Have New Bearing Surfaces Altered the Local Biological Reactions to Byproducts of Wear and Modularity?

The Surgical Options and Clinical Evidence for Treatment of Wear or Corrosion Occurring With THA or TKA

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