Adverse reactions to metal on polyethylene implants: Highly destructive lesions related to elevated concentration of cobalt and chromium in synovial fluid

Eltit, Felipe; Assiri, Ali; Garbuz, Donald S.; Duncan, Clivе P.; Masri, Bassam A.; Greidanus, Nelson V.; Bell, Robert H.; Sharma, Manju; Cox, Michael; Wang, Rizhi

doi:10.1002/jbm.a.36057

Cited by 36 publications

(60 citation statements)

References 33 publications

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“…XLPE acetabular liners are commonly used with metallic femoral heads in THR owing to their excellent in vitro and in vivo performance. However, many retrieval and case studies have shown that metal release from the taper‐trunnion junction of modular MoP THRs can cause an adverse reaction, leading to failure of the prostheses . This is the first long‐term hip simulator study to report material loss from the taper‐trunnion junction of the most commonly used bearing combination in hip prostheses.…”

Section: Discussionmentioning

confidence: 93%

“…Persson et al reported a 0.5% prevalence of revision surgery for ARMD after a mean follow‐up of 7 years in a one center observational cohort study of MoP THRs with the same Ti6Al4V femoral stems . Retrieval studies reported ARMD due to wear debris produced from the taper‐trunnion junction of modular MoP THRs . Furthermore, several case studies reported metal release due to fretting, corrosion, or both and associated pseudotumor formation after MoP THR .…”

Section: Introductionmentioning

confidence: 99%

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Hip simulator testing of the taper‐trunnion junction and bearing surfaces of contemporary metal‐on‐cross‐linked‐polyethylene hip prostheses

2019

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Adverse reaction to metal debris released from the taper‐trunnion junction of modular metal‐on‐polyethylene (MoP) total hip replacements (THRs) is an issue of contemporary concern. Therefore, a hip simulator was used to investigate material loss, if any, at both the articulating and taper‐trunnion surfaces of five 32‐mm metal‐on‐cross‐linked‐polyethylene THRs for 5 million cycles (Mc) with a sixth joint serving as a dynamically loaded soak control. Commercially available cobalt–chromium–molybdenum femoral heads articulating against cross‐linked polyethylene (XLPE) acetabular liners were mounted on 12/14 titanium (Ti6Al4V) trunnions. Weight loss (mg) was measured gravimetrically and converted into volume loss (mm3) for heads, liners, and trunnions at regular intervals. Additionally, posttest volumetric wear measurements of the femoral tapers were obtained using a coordinate measuring machine (CMM). The surface roughness (Sa) of femoral tapers was measured posttest. After 5 Mc, the mean volumetric wear rate for XLPE liners was 2.74 ± 0.74 mm3/Mc. The CMM measurements confirmed material loss from the femoral taper with the mean volumetric wear rate of 0.045 ± 0.024 mm3/Mc. The Sa on the worn area of the femoral taper showed a significant increase (p < 0.001) compared with the unworn area. No other long‐term hip simulator tests have investigated wear from the taper‐trunnion junction of contemporary MoP THRs. © Crown Copyright. Journal of Biomedical Materials Research Part B: Applied Biomaterials 108B:156–166, 2020.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Hip simulator testing of the taper‐trunnion junction and bearing surfaces of contemporary metal‐on‐cross‐linked‐polyethylene hip prostheses

2019

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“…Serum cobalt and chromium ion levels have been used to diagnose taper corrosion. Metal artifact reduction sequence MRI is an excellent diagnostic tool for evaluation of patients with elevated serum cobalt after MoP THA [11], [16], [17], [18]. In the present case, we used MoP articulation at the time of revision surgery and careful follow-up is required for MACC to occur.…”

Section: Discussionmentioning

confidence: 94%

“…A ceramic head could decrease corrosion products from MACC at the trunnion and taper interface. MACC occurred at the head-neck and neck-stem taper junction in which at least one of the components is fabricated from cobalt-chromium alloy [9], [16], [17]. The retained stem had no option of a titanium sleeve for the use of a new ceramic head.…”

Section: Discussionmentioning

confidence: 99%

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A case of bone necrosis with pseudotumor following metal-on-metal total hip arthroplasty

2018

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A case of bone necrosis with a pseudotumor following metal-on-metal total hip arthroplasty is presented. The patient showed no abnormal magnetic resonance findings 2 years postoperatively, but serum metal ion levels were elevated. The patient developed hip pain 3.5 years postoperatively, and bone necrosis with a pseudotumor was found. The present patient emphasized the fact that tissue necrosis associated with failed metal-on-metal bearing hip might not be limited to soft tissues, but bone necrosis could occur.

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CoCrMo metal release in metal‐on‐highly crosslinked polyethylene hip implants

et al. 2019

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Increasing cases of adverse local tissue reactions (ALTRs) associated with metal release have been observed in patients with metal‐on‐highly crosslinked polyethylene (MoP) hip implants, the most common design in total hip replacements. Studies have demonstrated the metal release from fretting corrosion at the head–neck junction, but rarely investigated tribocorrosion associated metal release at articulating surfaces in MoP hip implants. The objective of this study is to investigate both tribocorrosion at the articulating surfaces and fretting corrosion at the head–neck junction in CoCrMo femoral heads, as well as their association with metal species released in periprosthetic tissues and body fluids in MoP hip systems. Twenty‐three patients with ALTRs associated with MoP implants were included. Systematic analyses were performed on the wear damage in articulation, corrosion at the head–neck junction and their correlation with degradation products observed in synovial fluid, periprosthetic tissues, and serum. Results showed that tribocorrosion at the articulating surfaces contributed to the elevated concentration of both Co and Cr ions in serum, while fretting corrosion at the head–neck junction mainly released Co ions to serum. Both tribocorrosion at the articulating surfaces and fretting corrosion at the head–neck junction released particles rich in chromium and phosphate, the dominant particles found in synovial fluids and tissues. This study provides strong evidence that tribocorrosion at the articulating surfaces in MoP hip implants could result in significant metal release. This information should be taken into account when studying the mechanisms of ALTRs and developing strategies of preventing metal release in total hip replacements.

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Adverse reactions to metal on polyethylene implants: Highly destructive lesions related to elevated concentration of cobalt and chromium in synovial fluid

Cited by 36 publications

References 33 publications

Hip simulator testing of the taper‐trunnion junction and bearing surfaces of contemporary metal‐on‐cross‐linked‐polyethylene hip prostheses

Hip simulator testing of the taper‐trunnion junction and bearing surfaces of contemporary metal‐on‐cross‐linked‐polyethylene hip prostheses

A case of bone necrosis with pseudotumor following metal-on-metal total hip arthroplasty

CoCrMo metal release in metal‐on‐highly crosslinked polyethylene hip implants

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