Disassociation of a Cold-Welded Bimodular Titanium Femoral Stem by Intraoperative Ice Cooling

Abstract

Modularity in total hip arthroplasty allows a surgeon to have intraoperative versatility, allowing for fine adjustments of the femoral offset, leg length, and version. However, modularity can be a source of multiple complications. This case report describes a novel intraoperative solution for the problem of cold welding of a neck-stem junction using sterile ice to cryogenically disengage the modular components.

Cold Welding of the Synthes Femoral Neck System Encountered at Conversion to Arthroplasty

“…The culmination of these factors can lead to difficulty when removing implants as has been shown in several other case reports. 14-16…”

“…The culmination of these factors can lead to difficulty when removing implants as has been shown in several other case reports. [14][15][16] Fig. 3 Postoperative radiograph after removal of the Synthes FNS and conversion to THA.…”

Letter to the Editor on “Disassociation of a Cold-Welded Bimodular Titanium Femoral Stem by Intraoperative Ice Cooling”

“…Their unique technical solution should be remembered by all revision surgeons, and I agree with their logical approach to the difficult decision-making of when to remove a well-positioned, well-fixed, bimodular titanium femoral stem. I agree that current information about the Zimmer M/L taper prosthesis with Kinectiv Technology (Zimmer Biomet, Warsaw, IN) makes it a candidate for partial revision because (1) the neck is constructed of titanium (Ti) alloy, and although a Ti-Ti interface with the stem may cold-weld [ 1 ] or even corrode [ 2 , 3 ], it will likely not lead to an adverse local tissue reaction as there is no cobalt (Co) alloy involved; (2) the design length of this particular modular titanium neck is relatively short and therefore unlikely to break, distinct from longer Ti modular necks that are apt to fracture [ 4 , 5 ]; and (3) usage of a ceramic femoral head at the obverse taper on the neck should diminish corrosion and metal loss [ 6 ], and again, without a Co-alloy component in the mix, minimize the risk of adverse local tissue reactions. The decision to revise such a stem is complex [ 7 ], but the authors make a very logical argument for revising only the head and neck in their patient’s case.…”

“…I read with interest the article entitled “Disassociation of a cold-welded bimodular titanium femoral stem by intraoperative ice cooling” by Frandsen et al. [ 1 ], and I want to congratulate the authors on a report that deals with the challenging problems of stem, neck, and head modularity in contemporary total hip arthroplasty.…”