Corrosion and adverse local tissue reaction after total hip arthroplasty with a modular titanium alloy femoral neck

Abstract

This report describes a case of mechanically assisted crevice corrosion and secondary adverse local tissue reaction in a patient following a total hip arthroplasty, utilizing a modular neck (bi-modular) femoral component. Radiographic evaluation demonstrated a well-positioned, stable, cementless arthroplasty. Upon further evaluation, the patient had elevated serum cobalt and chromium levels, and magnetic resonance imaging demonstrated a periprosthetic pseudotumor. Corrosion of both the neck-stem and head-neck junctions was suspected. At the time of surgery, the neck-body junction was pristine; however, the head-neck junction of the implant demonstrated severe corrosive wear, a problem that has been reported only once previously with this particular bi-modular implant. This serves as a reminder that any modular junction may be susceptible to corrosion and not all bi-modular designs behave similarly.

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

“…A dual taper Ti alloy neck and Ti alloy stem design (M/L Taper) showed a higher prevalence (4.9%) of MACC than all other Ti alloy stems combined (1.2%) of the same manufacturer. For these stem design (M/L Taper Kinectiv) with a bi-modular Ti alloy neck on a Ti alloy stem and a CoCr 40 mm head, Canham et al [57] described in a case study a characteristic peri-prosthetic pseudo-tumor formation as an ALTR and an elevated serum cobalt level of 12.3 µg/L and chromium of 1.8 µg/L whereby the only potential source was the head-neck junction.…”

Titanium neck-titanium stem taper corrosion in a modular neck stem

“…To our knowledge, we report the first case of neck-stem taper discoloration in this Ti-alloy stem with a Ti modular neck and only the third case of ALTR with this stem in MoP THA. Our findings are particularly interesting as the Ti neck-Ti stem junction of modular neck stems is not typically implicated in ALTR [5] . Plummer et al.…”

“…and Canham et al. each previously identified 1 case of ALTR from corrosion at the head-neck junction of this modular neck stem in MoP THA but found no evidence of corrosion at the neck-stem junction [2] , [5] . Consideration should be given to avoiding the routine use of this stem, particularly given its vulnerability to corrosion at all taper junctions.…”

Response to letter to the editor on “Titanium neck–titanium stem taper corrosion in a modular neck stem”

“…We direct our readers to the first paragraph of the discussion section, in which we cite the 2 prior cases of ALTR reported with the stem that is the subject of our report [3,4]. Three reported cases of ALTR, as well as evidence of taper corrosion at both head-neck and neck-stem tapers, should give us pause before selecting this stem for routine use.…”