Adverse tissue reaction to corrosion at the neck-stem junction after modular primary total hip arthroplasty

Gkagkalis, Georgios; Mettraux, P.; Omoumi, Patrick; Mischler, S.; Rüdiger, Hannes A.

doi:10.1016/j.otsr.2014.11.003

Cited by 20 publications

(13 citation statements)

References 16 publications

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“…30,32,33,41,42 Relative motion is an indicator for the strength of the taper interlock. 43 Reduced relative motion can contribute to a reduction of wear and corrosion potential. 26 Although forces during cyclic loading (F max = 4300 N) were higher than two of the assembly force groups, the difference in seating depth between the assembly force groups was still present after 2000 loading cycles, indicating that cyclic loading does not provide similar seating as higher assembly forces within the amount of loading cycles used in this experiment.…”

Section: Discussionmentioning

confidence: 99%

Assembly force and taper angle difference influence the relative motion at the stem–neck interface of bi-modular hip prostheses

Haschke

Jauch-Matt

Sellenschloh

et al. 2016

Proc Inst Mech Eng H

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Bi-modular hip arthroplasty prostheses allow adaptation to the individual patient anatomy and the combination of different materials but introduce an additional interface, which was related lately to current clinical issues. Relative motion at the additional taper interface might increase the overall risk of fretting, corrosion, metallic debris and early failure. The aim of this study was to investigate whether the assembly force influences the relative motion and seating behaviour at the stem-neck interface of a bi-modular hip prosthesis (Metha(®); Aesculap AG, Tuttlingen, Germany) and whether this relation is influenced by the taper angle difference between male and female taper angles. Neck adapters made of titanium (Ti6Al4V) and CoCr (CoCr29Mo) were assembled with a titanium stem using varying assembly forces and mechanically loaded. A contactless eddy current measurement system was used to record the relative motion between prosthesis stem and neck adapter. Higher relative motion was observed for Ti neck adapters compared to the CoCr ones (p < 0.001). Higher assembly forces caused increased seating distances (p < 0.001) and led to significantly reduced relative motion (p = 0.019). Independent of neck material type, prostheses with larger taper angle difference between male and female taper angles exhibited decreased relative motion (p < 0.001). Surgeons should carefully use assembly forces above 4 kN to decrease the amount of relative motion within the taper interface. Maximum assembly forces, however, should be limited to prevent periprosthetic fractures. Manufacturers should optimize taper angle differences to increase the resistance against relative motion.

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Section: Discussionmentioning

confidence: 99%

Assembly force and taper angle difference influence the relative motion at the stem–neck interface of bi-modular hip prostheses

Haschke

Jauch-Matt

Sellenschloh

et al. 2016

Proc Inst Mech Eng H

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“…Passivity is the most common situation under the operating conditions of the alloy in the human body (analysis of retrievals showed there is an oxide film on the explants [68]). It is defined as the electrochemical situation where the formation of a 2–10 nm thin oxide film takes place.…”

Section: Chemical and Electro-chemical Behaviour Of Cocrmo In Body mentioning

confidence: 99%

In-situ generated tribomaterial in metal/metal contacts: Current understanding and future implications for implants

et al. 2017

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Artificial hip joints operate in aqueous biofluids that are highly reactive towards metallic surfaces. The reactivity at the metal interface is enhanced by mechanical interaction due to friction, which can change the near-surface structure of the metal and surface chemistry. There are now several reports in the literature about the in-situ generation of reaction films and tribo-metallurgical transformations on metal-on-metal hip joints. This paper summarizes current knowledge and provides a mechanistic interpretation of the surface chemical and metallurgical phenomena. Basic concepts of corrosion and wear are illustrated and used to interpret available literature on in-vitro and in-vivo studies of metal-on-metal hip joints. Based on this review, three forms of tribomaterial, characterized by different combinations of oxide films and organic layers, can be determined. It is shown that the generation of these tribofilms can be related to specific electrochemical and mechanical phenomena in the metal interface. It is suggested that the generation of this surface reaction layer constitutes a way to minimize (mechanical) wear of MoM hip implants.

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“…The modular stem also yields concerns regarding taper junction corrosion. 20 THA with trochanteric osteotomy is another option for THA with severe LLD. 21 With trochanteric osteotomy, exposure of the acetabulum could be facilitated.…”

Section: Discussionmentioning

confidence: 99%

Two-stage total hip arthroplasty following skeletal traction after extensive soft tissue release for severe limb-length discrepancy

Lee

Yoon

2019

HIP International

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Introduction: To maximise limb-length discrepancy (LLD) resolution during total hip arthroplasty (THA) for untreated developmental hip dysplasia or septic hip sequelae, THA following limb lengthening was introduced using different methods. We aimed to evaluate 2-stage THA results following limb lengthening via skeletal traction after extensive soft tissue release. Method: In total, 24 hips with severe LLD in 10 men and 14 women (mean age, 49.6 ± 15.2 years) underwent 2-stage THA and were followed thereafter (mean 6.3 ± 3.7 years). The entire abductor muscle origin was subperiosteally released from the ilium, and the soft tissue around the hip joint, including the psoas tendon, short external rotator, joint capsule, and adductor tendon, was extensively released. 2-stage THA was performed after 2-week skeletal traction using proximal tibial pins. During the final THA, 7 hips necessitated subtrochanteric shortening osteotomy (STO) for hip joint reduction. We evaluated the clinical and radiological results and especially focused on LLD and neurological complications. Results: The Harris Hip Score improved from 57.1 ± 9.6 to 88.3 ± 6.3 points. No patients showed worse abductor power. LLD improved from 5.0 ± 2.0 to 1.4 ± 1.0 cm. No permanent neurological complications occurred except for 1 transient peroneal nerve palsy during traction, which resolved fully after cessation of traction. There were 2 hips with STO nonunion treated with osteosynthesis and stem revision. Conclusion: 2-stage THA following skeletal traction after extensive soft tissue release showed favourable results in terms of neurologic complication prevention and LLD resolution. However, a large proportion of patients still necessitated shortening osteotomy with a risk for nonunion at the osteotomy site. Though surgical procedures might be complicated and necessitate longer hospital stays, 2-stage THA with extensive soft tissue release might be an alternative treatment option for patients with severe LLD willing to resolve their limb length discrepancy.

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Adverse tissue reaction to corrosion at the neck-stem junction after modular primary total hip arthroplasty

Cited by 20 publications

References 16 publications

Assembly force and taper angle difference influence the relative motion at the stem–neck interface of bi-modular hip prostheses

Assembly force and taper angle difference influence the relative motion at the stem–neck interface of bi-modular hip prostheses

In-situ generated tribomaterial in metal/metal contacts: Current understanding and future implications for implants

Two-stage total hip arthroplasty following skeletal traction after extensive soft tissue release for severe limb-length discrepancy

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