Corrosion and Adverse Local Tissue Reaction in One Type of Modular Neck Stem

Ghanem, Elie; Ward, Daniel M.; Robbins, Claire E.; Nandi, Sumon; Bono, James V.; Talmo, Carl T.

doi:10.1016/j.arth.2015.04.039

Cited by 43 publications

(32 citation statements)

References 34 publications

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“…Revision modular tapered stems have a known point of weakness at the modular interfaces [3], [4], [7]. Corrosion, fretting, and particulate debris have been observed at this spot [7], [13], and most stem fractures occur in this region [14]. However, reports describing fractures through the mid-stem portion of a modern tapered stem are rare [5], [11].…”

Section: Discussionmentioning

confidence: 99%

Fracture risk of tapered modular revision stems: a failure analysis

et al. 2018

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Fractures of well-ingrown femoral components are a rare and often challenging complication after revision total hip arthroplasty. Prior series have documented catastrophic failure at the modular junction of revision femoral components. However, to the authors' knowledge, there has been only 1 report of a mid-stem fracture of a modular tapered revision stem. The present article reports 2 cases of fatigue fractures (14 months and 10 years after implantation) of a tapered modular revision stem. It presents the results of the fracture surface analysis, discusses the etiology of failure, and presents the authors' recommendations on how to best avoid this complication.

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Section: Discussionmentioning

confidence: 99%

Fracture risk of tapered modular revision stems: a failure analysis

et al. 2018

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“…Corrosion, fretting, and particulate debris have been observed at this junctional interface [19], [20] and most fractures occur in this region [21]. The Emperion stem was taken off the market, leaving S-ROM the only modular proximal ingrowth stem design available.…”

Section: Discussionmentioning

confidence: 99%

Fracture of an S-ROM stem at the sleeve-stem junction

et al. 2018

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Fracture of a well-ingrown femoral component is a rare and often challenging complication. Modular junctions and sleeve interfaces have been identified as one potential point of weakness with corrosion and fretting being contributing factors to ultimate femoral component fracture. Stem fractures at the sleeve interface were reported occasionally for the proximal ingrowth modular Emperion System (Smith and Nephew, Memphis, TN). However, this failure mechanism has been reported infrequently, often associated with corrosion at the modular junction, for the similarly designed S-ROM system (DePuy Orthopedics Inc., Warsaw, IN). We present the case of a 52-year-old patient, with a body weight of 84 kg (185 lbs) and a body mass index of 30.6 kg/m2, who suffered a fatigue fracture of a 14 × 09 × 130 mm S-ROM stem 42 months after implantation. The present study presents the results of the surface analysis, discusses possible failure mechanisms, provides treatment guidelines, and a review of the literature revealing 15 cases of failure at the level of the stem-sleeve junction. In particular, modifiable risk factors for potential stem failure, including stem diameter, stem offset, and the resulting cantilever bending forces on the proximal sleeve-stem junction, are discussed in detail.

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“…The surgical and biomechanical advantages of modularity are recognised, but its clinical benefits remain controversial (1,17,18). Ti modular necks can fracture or dissociate at the Morse taper due to surface cracks, while CoCr modular necks withstand greater loads but are associated with metal ions release and corrosion (19,20). Though Ti-Ti modular junctions are previously thought to be at greater risks of fracture, their lower potential of generating metal ions are less harmful to surrounding soft tissues than Ti-CoCr modular junctions (7,21,27).…”

Section: Discussionmentioning

confidence: 99%

“…It has been demonstrated that Ti modular necks can fracture or dissociate at the Morse taper due to surface cracks (19,20). Conversely, CoCr modular necks withstand greater loads but are associated with corrosion and metal ion release, which could lead to adverse local tissue reactions (19,20). Though Ti-Ti modular junctions are more likely to fracture, their lower potential to generate metal ions makes them less harmful to surrounding soft tissues, compared to Ti-CoCr modular junctions (7,21).…”

Section: Introductionmentioning

confidence: 99%

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Midterm outcomes of titanium modular femoral necks in total hip arthroplasty

Collet¹,

Atanasiu

Cussac³

et al. 2017

Annals of Translational Medicine

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Background: Modular femoral necks present surgical and biomechanical advantages in total hip arthroplasty (THA), but their benefits remain controversial due to risks of corrosion and fracture at the additional junction. This study aimed to report 10-year survival and clinical outcomes of a titanium femoral stem with a titanium modular neck in consecutive series. Methods:The authors reviewed the records of 97 patients (99 THAs) using uncemented modular stem and ceramic-on-ceramic acetabular components. Patients were evaluated at minimum follow-up of 5 years using the Harris Hip Score (HHS) and Postel Merle-D'Aubigné score (PMA). Survival was calculated using the Kaplan-Meier (KM) method with any reoperation or revision as endpoint.Results: From the original cohort, 14 patients died, 6 were lost to follow-up, and 5 had revision operations with exchange of the femoral stem. The KM survival at 10 years was 94.2% (CI, 86.5-97.5). Clinical assessment was performed on 67 of the 72 patients (69 of the 74 hips) presently living with their original THA components. At mean follow-up of 9.4±1.0 years (median, 10; range, 5-11), the HHS was 93.6±8.2 and the PMA score 17.0±1.6. The X-rays revealed no signs of adverse reactions or bone loss. Conclusions:The uncemented titanium hip stem with modular titanium neck provided a satisfactory 10-year survival and clinical outcomes. Neck modularity enabled restoration of patient-specific femoral offset and limb length thanks to five possible neck configurations, though greater follow up is required to confirm the long-term benefits and safety of this design concept.

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Corrosion and Adverse Local Tissue Reaction in One Type of Modular Neck Stem

Cited by 43 publications

References 34 publications

Fracture risk of tapered modular revision stems: a failure analysis

Fracture risk of tapered modular revision stems: a failure analysis

Fracture of an S-ROM stem at the sleeve-stem junction

Midterm outcomes of titanium modular femoral necks in total hip arthroplasty

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