Adverse Tissue Reactions in Modular Exchangeable Neck Implants: A Report of Two Cases

Werner, Stephanie; Bono, James V.; Nandi, Sumon; Ward, Daniel M.; Talmo, Carl T.

doi:10.1016/j.arth.2012.07.026

Cited by 36 publications

(32 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, reports of complications at the neck-stem junction are generating increasing concern [1][2][3][4][5][6]. In addition, registry data indicate higher revision rates compared to standard implants without neck-stem modularity [7].…”

Section: Introductionmentioning

confidence: 99%

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

Gkagkalis¹,

Mettraux²,

Omoumi³

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

View full text Add to dashboard Cite

Complications related to the neck-stem junction of modular stems used for total hip arthroplasty (THA) are generating increasing concern. A 74-year-old male had increasing pain and a cutaneous reaction around the scar 1 year after THA with a modular neck-stem. Imaging revealed osteolysis of the calcar and a pseudo-tumour adjacent to the neck-stem junction. Serum cobalt levels were elevated. Revision surgery to exchange the stem and liner and to resect the pseudo-tumour was performed. Analysis of the stem by scanning electron microscopy and by energy dispersive X-ray and white light interferometry showed fretting corrosion at the neck-stem junction contrasting with minimal changes at the head-neck junction. Thus, despite dry assembly of the neck and stem on the back table at primary THA, full neck-stem contact was not achieved, and the resulting micromotion at the interface led to fretting corrosion. This case highlights the mechanism of fretting corrosion at the neck-stem interface responsible for adverse local tissue reactions. Clinical and radiological follow-up is mandatory in patients with dual-modular stems.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Gkagkalis¹,

Mettraux²,

Omoumi³

et al. 2015

Orthopaedics & Traumatology: Surgery & Research

View full text Add to dashboard Cite

show abstract

“…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%

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

Engh

Padgett

2014

Clin Orthop Relat Res

View full text Add to dashboard Cite

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.

show abstract

“…Resultant wear debris and corrosion products may provoke a host-mediated immune hypersensitivity response analogous to that encountered with metal-on-metal bearings, often called adverse local tissue reaction. Terms such as adverse reaction to metal debris and pseudotumor have also been applied to this process, the histologic correlate of which is aseptic lymphocytic vasculitis-associated lesion (ALVAL) (1,(4)(5)(6)(7)(8). In severe cases, adverse local tissue reaction is associated with rapidly progressive soft-tissue damage, leading not only to implant failure but also to poor outcomes after revision arthroplasty in the setting of advanced pre-existing tissue damage at the time of revision surgery (9 Volumes of synovitis and osteolysis were calculated by using a previously validated method of manual segmentation on coronal multiacquisition variable resonance image combination or axial FSE images.…”

Section: Imaging Techniquementioning

confidence: 99%

“…Burge et al in hip arthroplasty stems with modular junctions (2,(4)(5)(6)(7)(8)(20)(21)(22). Failure at these junctions is typically attributed to a complex process termed tribocorrosion, which may be regarded as degradation of materials subjected to mechanical loading in a corrosive environment.…”

Section: Musculoskeletal Imaging: Adverse Tissue Reactions Around Rejmentioning

confidence: 99%

MR Imaging of Adverse Local Tissue Reactions around Rejuvenate Modular Dual-Taper Stems

Burge¹,

Gold²,

Lurie³

et al. 2015

Radiology

View full text Add to dashboard Cite

Adverse Tissue Reactions in Modular Exchangeable Neck Implants: A Report of Two Cases

Cited by 36 publications

References 23 publications

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

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

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

MR Imaging of Adverse Local Tissue Reactions around Rejuvenate Modular Dual-Taper Stems

Contact Info

Product

Resources

About