Head Taper Corrosion Causing Head Bottoming Out and Consecutive Gross Stem Taper Failure in Total Hip Arthroplasty

Morlock, Michael M.; Dickinson, Emilie C.; Günther, Klaus‐Peter; Bünte, Dennis; Polster, Valerie

doi:10.1016/j.arth.2018.07.017

Cited by 43 publications

(45 citation statements)

References 32 publications

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“…Series of clinical complications can be caused by head-taper corrosion, including ALTRs, pseudotumors and even the unacceptable gross taper failures [30]. Recently, MRI and ultrasound are regards as best methods for detecting ALTRs and pseudotumors caused by metal debris [20,21].…”

Section: Discussionmentioning

confidence: 99%

“…Besides the adverse reactions of metal debris, the material loss caused by corrosive and mechanical abrasion can destroy the force-locking of the head-taper junction, further exacerbating the wearing-out of taper material. The end phase of this process was gross stem-taper failure [30]. Monitoring of head-taper migration in context of corrosive processes is essential.…”

Section: Discussionmentioning

confidence: 99%

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Model-Based Roentgen Stereophotogrammetric Analysis to Monitor the Head–Taper Junction in Total Hip Arthroplasty in Vivo—And They Do Move

Sonntag

Kretzer

et al. 2020

Materials

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Model-based Roentgen stereophotogrammetric analysis (RSA) using elementary geometrical shape (EGS) models allows migration measurement of implants without the necessity of additional attached implant markers. The aims of this study were: (i) to assess the possibility of measuring potential head–taper movement in THA in vivo using model-based RSA and (ii) to prove the validity of measured head–taper migration data in vitro and in vivo. From a previous RSA study with a 10 years follow-up, retrospectively for n = 45 patients head–taper migration was calculated as the relative migration between femoral ball head and taper of the femoral stem using model-based RSA. A head–taper migration of 0.026 mm/year can be detected with available RSA technology. In vitro validation showed a total migration of 268 ± 11 µm along the taper axis in a similar range to what has been reported using the RSA method. In vivo, a proof for interchangeable applicability of model-based RSA (EGS) and standard marker-based RSA methods was indicated by a significant deviation within the migration result after 12-month follow-up for all translation measurements, which was significantly correlated to the measured head–taper migration (r from 0.40 to 0.67; p < 0.05). The results identified that model-based RSA (EGS) could be used to detect head–taper migration in vivo and the measured movement could be validated in vitro and in vivo as well. Those findings supported the possibility of applying RSA for helping evaluate the head–taper corrosion related failure (trunnionosis).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Model-Based Roentgen Stereophotogrammetric Analysis to Monitor the Head–Taper Junction in Total Hip Arthroplasty in Vivo—And They Do Move

Sonntag

Kretzer

et al. 2020

Materials

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“…His right lower extremity was 3.5 cm shorter than his left. The anteroposterior and lateral radiographs of the affected hip demonstrated what appears to be a GTF [3] , [6] , [7] ( Fig. 3 ).…”

Section: Case Historymentioning

confidence: 97%

“…MACC at the femoral head-trunnion interface eventually increases susceptibility to adverse local tissue reaction which is a local hypersensitivity response to Co fretting and corrosion products from MACC [5] . Long-standing MACC causes material loss at the taper junction which in rare cases may lead to gross trunnion failure (GTF) with frank taper disassociation and issues such as marked trunnion deformity, fracture, with or without dislocation at the femoral head-trunnion interface [3] , [5] , [6] , [7] .…”

Section: Introductionmentioning

confidence: 99%

Gross trunnion failure after a metal-on-polyethylene total hip arthroplasty leading to dissociation at the femoral head-trunnion interface

et al. 2019

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Gross trunnion failure (GTF) leading to dissociation at the femoral head-trunnion interface is an uncommon complication after total hip arthroplasty (THA). The incidence of this complication is currently unknown due to the limited number of reported cases but it is significantly more common in the context of a recalled femoral head. This report details the case of a gross trunnion failure and secondary polyethylene failure of a non-recalled metal-on-polyethylene primary THA from a taper type previously reported to be associated with an increased prevalence of mechanically assisted crevice corrosion (MACC). This case describes a 77-year-old man who was 10 years status post right THA presenting with acute-onset right hip pain after trying to rise from a seated position. Radiographs showed that the right femoral head was dissociated from the femoral component. At the time of surgical revision, there was extensive dark metallic debris in the hip joint. A revision THA was performed using a modular revision system. Clinicians must be aware that MACC can eventually lead to GTF, which can result in dissociation at the femoral head-trunnion interface in metal-on-polyethylene primary THA. Further research is needed to determine patient and implant factors that make patients susceptible to MACC/GTF so that adequate screening and patient counseling can be performed.

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“…These layers are not simply deposits on the original surface, but represent changes deep inside the material itself. While despite the massive release of titanium particles and ions, often there are no clinical symptoms, this paves the way for massive loss of material and even catastrophic failure [4,16].…”

Section: Fretting Corrosionmentioning

confidence: 99%

Metal Ion Release after Hip and Knee Arthroplasty – Causes, Biological Effects and Diagnostics

et al. 2019

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All metal implants in human bodies corrode which results in metal ions release. This is not necessarily a problem and represents for most patients no hazard. However, if a critical metal ion concentration is exceeded, local or rarely systemic problems can occur. This article summarizes the mechanisms of metal ion release and its clinical consequences. Several situations can result in increased metal ion release: metal-on-metal hip arthroplasties with increased wear, increased micromotion at taper interfaces, direct metal-metal contact (polyethylene wear, impingement), erroneously used metal heads after ceramic head fracture. Possible problems are in most cases located close to the concerned joint. Furthermore, there are reports about toxic damage to several organs. Most of these reports refer to erroneously used metal heads in revisions after a broken ceramic head. There is currently no evidence of carcinogenic or teratogenic effects of implants but data is not sufficient to exclude possible effects. Cobalt and chromium blood levels (favorably in whole blood) should be measured in patients with suspected elevated metal ions. According to current knowledge levels below 2 µg/l seem to be uncritical, levels between 2 and 7 µg/l are considered borderline with unknown biological consequences and levels above 7 µg/l indicate a local problem which should be further diagnosed. Metal ion levels always need to be interpreted together with clinical symptoms and imaging results.

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Head Taper Corrosion Causing Head Bottoming Out and Consecutive Gross Stem Taper Failure in Total Hip Arthroplasty

Cited by 43 publications

References 32 publications

Model-Based Roentgen Stereophotogrammetric Analysis to Monitor the Head–Taper Junction in Total Hip Arthroplasty in Vivo—And They Do Move

Model-Based Roentgen Stereophotogrammetric Analysis to Monitor the Head–Taper Junction in Total Hip Arthroplasty in Vivo—And They Do Move

Gross trunnion failure after a metal-on-polyethylene total hip arthroplasty leading to dissociation at the femoral head-trunnion interface

Metal Ion Release after Hip and Knee Arthroplasty – Causes, Biological Effects and Diagnostics

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