Disassembly of a Modular Femoral Component After Femoral Head Prosthetic Replacement

Shiga, Toshiki; Mori, Masaki; Hayashida, Tatsuro; Fujiwara, Yasuhiro; Ogura, Taku

doi:10.1016/j.arth.2009.03.001

Cited by 12 publications

(18 citation statements)

References 5 publications

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“…In head-neck dissociation, postulated mechanisms include strong distraction forces caused by the inferior edge of the femoral head becoming caught on the rim of the acetabular component during reduction of a dislocation [ 19 ] and excessive external rotation in the presence of a constrained liner, in which the elevated liner would act as a fulcrum at the head and neck junction [ 6 ]. However, we know that a considerable force is required to achieve dissociation of a well impacted head, with cited values including 3003 ± 623 N [ 20 ] and 427 kg [ 21 ]. Adequate impaction of the head-neck interface is achieved by a strong blow with a 0.5 kg mallet and a femoral head driver, in combination with the cyclic impaction loading in the normal activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

“…Another theory is that “pumping phenomenon,” a mechanical engineering term, may be responsible for rising air pressure in the inner head, giving rise to an unlocked tapered neck where there is air trapping between the inner head and tapered stem. Smaller forces are required for dissociation as sealed air pushes back on the neck and unlocks the taper mechanism of the inner head, causing separation [ 21 ]. However, in the case presented here, we see the complication arise in a nontraumatic scenario, after 10 years of full weight bearing, which makes the possibilities of high distraction forces and a pumping phenomenon seem unlikely.…”

Section: Discussionmentioning

confidence: 99%

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Late Nontraumatic Dissociation of the Femoral Head and Trunnion in a Total Hip Arthroplasty

Parker

Khan

Mellor

2015

Case Reports in Orthopedics

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Background. Modular total hip arthroplasties are increasingly popular because customisation allows optimal restoration of patient biomechanics. However, the introduction of component interfaces provides greater opportunities for failure. We present a case of late nontraumatic dissociation of the head-neck interface, more than 10 years after insertion. Case Description. A 58-year-old woman had a left metal-on-metal total hip arthroplasty in 2002 for hip dysplasia. Following an uneventful 10-year period, she presented to hospital in severe pain after standing from a seated position, and radiographs demonstrated complete dissociation of the modular femoral head from the stem, with the femoral head remaining in its cup. There was no prior trauma or infection. Mild wear and metallosis were present on the articulating surface between the femoral head and trunnion. Soft tissues were unaffected. Discussion and Conclusions. This is the latest occurrence reported to date for nontraumatic component failure in such an implant by more than 7 years. The majority of cases occur in the context of dislocation and attempted closed reduction. We analyse and discuss possible mechanisms for failure, aiming to raise awareness of this potential complication and encouraging utmost care in component handling and insertion, as well as the long term follow-up of such patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Late Nontraumatic Dissociation of the Femoral Head and Trunnion in a Total Hip Arthroplasty

Parker

Khan

Mellor

2015

Case Reports in Orthopedics

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“…However, there are limited reports on acute spontaneous dissociation of head and neck at the taper junction in bipolar hemiarthroplasty. A previous case reported inner femoral head disassembly from the stem-neck taper junction which occurred after revision of the head of a bipolar hip prosthesis [6] . The present study reports an acute disassembly of a primary bipolar hemiarthroplasty at the femoral head and stem-neck taper junction in a patient with nerve palsy.…”

Section: Introductionmentioning

confidence: 99%

Spontaneous dissociation of bipolar hip hemiarthroplasty in a patient with nerve palsy: A case report and review of the literature

Yuenyongviwat

Iamthanaporn

Hongnaparak

2015

International Journal of Surgery Case Reports

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HighlightsAcute disassembly of a bipolar hemiarthroplasty at the femoral head and stem-neck taper junction is rare.Dissociation of bipolar hemiarthroplasty is a complex complication that requires operative treatment.The mechanism and cause of dissociation should be identified before the operation.The authors suggest that to prevent this condition, preoperative planning and proper techniques should be done as an index procedure.

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“…These marketed advantages have, however, come with increased risks and complications [4,15,27,44,70]. Unfortunately, adding another metal taper junction may increase the burden of corrosion debris and the risk of local tissue reactions as well as serve as a possible weak link that can increase the risk of a catastrophic failure [4,15,27,44,70]. As with any additional technological advancement in implant designs, both alternative bearings and increased modularity add cost to the implants in most cases.…”

Section: Introductionmentioning

confidence: 99%

How Have Alternative Bearings and Modularity Affected Revision Rates in Total Hip Arthroplasty?

Mihalko

Wimmer

Pacione

et al. 2014

Clin Orthop Relat Res

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Background Total hip arthroplasty (THA) continues to be one of the most successful surgical procedures in the medical field. However, over the last two decades, the use of modularity and alternative bearings in THA has become routine. Given the known problems associated with hardon-hard bearing couples, including taper failures with more modular stem designs, local and systemic effects from metal-on-metal bearings, and fractures with ceramic-onceramic bearings, it is not known whether in aggregate the survivorship of these implants is better or worse than the metal-on-polyethylene bearings that they sought to replace. Questions/purposes Have alternative bearings (metal-onmetal and ceramic-on-ceramic) and implant modularity decreased revision rates of primary THAs?Methods In this systematic review of MEDLINE and EMBASE, we used several Boolean search strings for each topic and surveyed national registry data from Englishspeaking countries. Clinical research (Level IV or higher) with C 5 years of followup was included; retrieval studies and case reports were excluded. We included registry data at C 7 years followup. A total of 32 studies (and five registry reports) on metal-on-metal, 19 studies (and five registry reports) on ceramic-on-ceramic, and 20 studies (and one registry report) on modular stem designs met inclusion criteria and were evaluated in detail. Insufficient data were available on metal-on-ceramic and ceramic-onmetal implants, and monoblock acetabular designs were evaluated in another recent systematic review so these were not evaluated here.One of the authors (WMM) receives royalty payments, during the study period, an amount of USD 10,000 to USD 100,000 from B Braun/Aesculap Inc (Center Valley, PA, USA) and less than USD 10,000 from Elsevier Inc (Philadelphia, PA, USA); receives USD 10,000 to USD 100,000 as a consultant for B Braun/Aesculap Inc and less than USD 10,000 from Medtronic Inc (Memphis, TN, USA); receives research funding, during the study period, an amount of less than USD 10,000 from B Braun/Aesculap Inc and less than USD 10,000 Stryker Inc (Mahwah, NJ, USA); and serves on the editorial boards for the Journal of Arthroplasty, The Knee, the International Journal of Orthopaedics, and The Journal of Long Term Effects of Medical Implants. One of the authors (MAW) receives institutional funding in the amount of less than USD 10,000 from Biomet, Inc (Warsaw, IN, USA), USD 10,000 to USD 100,000 from CeramTec GmbH (Lauf, Germany), and material support from Zimmer Inc (Warsaw, Inc, USA) and B Braun/Aesculap AG. He is an unpaid consultant for Endolab GmbH and a paid consultant receiving an amount of less than USD 10,000 from Irwing Fritche Urquhart & Moore LLC (New Orleans, LA, USA). One of the authors (MPL) owns Zimmer Holdings, Inc stock but received no payments during the study period. Results There was no evidence in the literature that alternative bearings (either metal-on-metal or ceramic-onceramic) in THA have decreased revision rates. Registry data, however, showed that large he...

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Disassembly of a Modular Femoral Component After Femoral Head Prosthetic Replacement

Cited by 12 publications

References 5 publications

Late Nontraumatic Dissociation of the Femoral Head and Trunnion in a Total Hip Arthroplasty

Late Nontraumatic Dissociation of the Femoral Head and Trunnion in a Total Hip Arthroplasty

Spontaneous dissociation of bipolar hip hemiarthroplasty in a patient with nerve palsy: A case report and review of the literature

How Have Alternative Bearings and Modularity Affected Revision Rates in Total Hip Arthroplasty?

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