Catastrophic Femoral Head-Stem Trunnion Dissociation Secondary to Corrosion

Ko, Laura Matsen; Chen, Antonia F.; Deirmengian, Gregory K.; Hozack, William J.; Sharkey, Peter F.

doi:10.2106/jbjs.15.00914

Cited by 57 publications

(38 citation statements)

References 16 publications

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“…When we consider the entire population of revisions in our series, almost all femoral head sizes at and above 36mm have reported failures. In another recent series of 5 cases of failed Accolade TMZF and LFIT femoral head, all of the femoral head diameters and offsets reported were listed in the recall[9]. …”

Section: Discussionmentioning

confidence: 99%

“…We were unable to assess the role of surgical technique in trunnion failure. The technique used to impact the femoral head onto the trunnion has been postulated to play a role in trunnion corrosion[9]. We cannot comment on this, however the identical technique was used on other femoral stems used before and after this implant in our practice.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical studies have reported ALTR association with head-neck taper corrosion[6, 7] and with gross trunnion failure (GTF)[8]. A small series of cases involving GTF with the Low Friction Ion Treatment (LFIT) CoCr femoral head and the Accolade titanium-molybdenum-zirconium-iron alloy (TMZF) stem, as well as other designs, has also been reported[9, 10]. …”

Section: Introductionmentioning

confidence: 99%

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Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head

Urish

Hamlin

Plakseychuk

et al. 2017

The Journal of Arthroplasty

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Background Gross trunnion failure (GTF) is a rare complication in total hip arthroplasty reported across a range of manufacturers. Specific lots of the Stryker LFIT Anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August of 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF. Methods We report on 28 patients (30 implants) with either GTF (n=18) or head-neck taper corrosion (n=12) of the LFIT CoCr femoral head and the Accolade TMZF femoral stems. All of these cases were associated with adverse local tissue reaction (ALTR) requiring revision of the THA. Results In our series, a conservative estimate of the incidence of failure was 4.7% (n = 636 total implanted) at 8.0±1.4 years from the index procedure. Failures were associated with a high offset 127° femoral stem nec k angle and increased neck lengths. 43.3% (13/30) of the observed failures included implant sizes outside of the voluntary recall (27.8% (5/18) of the GTF and 75.0% (8/12) of the taper corrosion cases). Serum cobalt and chromium levels were elevated (Cobalt: 8.4±7.0μg/mL; Chromium: 3.4±3.3μ/L; Cobalt/Chromium ratio: 3.7). MARS MRI demonstrated large cystic fluid collections typical with ALTR. During revision, a pseudotumor was observed in all cases. Pathology suggested a chronic inflammatory response. Impending GTF could be diagnosed based on aspiration of black synovial fluid and an oblique femoral head as compared to the neck taper on radiographs. Conclusion In our series of the recalled LFIT CoCr femoral head, the risk of impending GTF or head-neck taper corrosion should be considered as a potential diagnosis in a painful Accolade TMZF THA with unknown etiology. Almost half of the failures we observed included sizes outside of the voluntary recall.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head

Urish

Hamlin

Plakseychuk

et al. 2017

The Journal of Arthroplasty

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“…One of the stems in the literature associated with frank disassociation in vivo is the Accolade TMZF; retrieved specimens exhibit substantial male taper abrasion following disassociation (Fig. ) . Some case reports have suggested the failure mode must involve corrosion and fretting of the stem taper, but the specific mechanisms remain undetermined .…”

mentioning

confidence: 99%

Role of corrosion in taper failure and head disassociation in total hip arthroplasty of a single design

Martin

Jenkins

Citters

2018

Journal Orthopaedic Research

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Modular junctions have been associated with corrosion in total hip arthroplasty. In a small number of cases, disassociation of the femoral head from the stem following gross wear of the taper has been reported. The purpose of this study was to investigate the role of corrosion in the development of mechanical changes leading to disassociation. Twenty-one retrieved stems and heads of one design previously reported with head disassociation were identified in an IRB-approved database. Components were scored for corrosion and measured for material loss. Stem alloy hardness was measured. Parametric and non-parametric statistics were performed (α < 0.05). Seven of twenty-one stems demonstrated gross material loss of the stem taper and head disassociation. The maximum linear depth (MLD) of material loss on stem tapers without dissociation and all head bores was 7.63 ± 6.04 and 63.76 ± 60.83 μm, respectively. Hardness of the stem material was statistically distinct, but similar to other stem materials. Results suggest material loss via corrosion at the head bore loosens the taper lock, allowing relative motion leading to abrasive wear of the stem taper. All cases of disassociation occurred at greater than 65 months with a minimum of 50 μm of loss at on the head bore. It may be warranted to survey patients with systems reporting head disassociation; for this system, including recalled heads, risk appears to begin after 6 years in vivo. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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“…In the last decade, metallic alloy interfaces have come under increased scrutiny because of their contribution to the failure of metal‐on‐metal THAs and modular neck stems . Published case series show conventional THAs with modular cobalt–chrome heads on polyethylene articulations that resulted in adverse local tissue reaction (ALTR) associated with trunnion corrosion . The proposed mechanism for these failures is mechanically assisted crevice corrosion (MACC) at the taper interface.…”

mentioning

confidence: 99%

The onset of fretting at the head‐stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions

Rowan

Wach

Wright

et al. 2018

Journal Orthopaedic Research

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Mechanically assisted crevice corrosion (MACC) is a mechanism for trunnion damage in total hip arthroplasties (THAs). Retrieval studies have shown reduced MACC-related damage for ceramic heads compared with cobalt-chromium (CoCr) heads. We propose that ceramic heads demonstrate fretting at higher cyclic compressive loads than CoCr heads on titanium alloy trunnions in a simulated corrosion model. A closed electrochemical chamber was used to measure fretting current onset loads for two modern titanium alloy trunnions (Zimmer 12/14 and Stryker V-40) in which trunnion failure has been reported. Ceramic and CoCr alloy 36 + 0 mm heads were impacted on each trunnion and cyclically loaded at 3 Hz with increasing magnitude from 100 to 3,400 N for 540 cycles. Onset load was the cyclic compressive load at which the slope of the average fretting current increased significantly. A CoCr head with V40 trunnion demonstrated the lowest onset load (1,400 N), while the V40 trunnion with a ceramic head showed the highest onset load (2,200 N). Significant differences occurred in average fretting current between head materials for V40 trunnions (p < 0.001) at loads over 2,000 N. CoCr-12/14 and ceramic-12/14 couples demonstrated similar onset loads (2,000 N). All head-trunnion combinations showed cyclical fretting response to loading at 100 N. Head material composition was observed to increase fretting at the taper junction but the effect was taper geometry dependent. Using ceramic heads may reduce the phenomena of trunnion fretting and corrosion but the effect of both trunnion geometry and metallurgy warrants further investigation. Statement of clinical significance: Trunnion corrosion may occur with titanium alloy stems regardless of the head material used. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1630-1636, 2018.

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Catastrophic Femoral Head-Stem Trunnion Dissociation Secondary to Corrosion

Cited by 57 publications

References 16 publications

Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head

Trunnion Failure of the Recalled Low Friction Ion Treatment Cobalt Chromium Alloy Femoral Head

Role of corrosion in taper failure and head disassociation in total hip arthroplasty of a single design

The onset of fretting at the head‐stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions

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