<p>Three Femoral Stem Designs Without Corrosion: A Review of 2095 Stems</p>

Abstract

Introduction Corrosion at the head–neck interface of modular components in total hip arthroplasty (THA) has been reported as a cause of failure of modern total hip replacement implants. While this method of failure has been well described, it remains poorly understood. The purpose of this study is to review the three most commonly used uncemented femoral stems at our institution over the last fifteen years and to correlate any established risk factors with rates of revision, particularly corrosion. Methods We reviewed 2095 patients from March 2000 to September 2015 who underwent total hip arthroplasty with one of three uncemented femoral stem designs. All stems were made of a Ti6Al4V alloy with a 12/14 taper design. We included only those stems coupled with a CoCr head and a highly crosslinked polyethylene liner. We evaluated age, gender, body mass index (BMI), femoral head size, head length, neck angle and offset and correlated these to the incidence of all cause revision, as well as revision excluding infection. Results There were no recognized corrosion-related revisions identified. There was no association between age, BMI, gender, head length, neck angle and offset to all cause revision or revision with infection excluded (p>0.05). Femoral head size less than 32mm was associated with higher all cause revision rates (OR 4.60 (95% CI 1.8, 11.8)) and when excluding infection as a reason for revision (OR 4.94 (95% CI 1.7, 14.41)). Conclusion Over the last fifteen years, we have not identified any cases of corrosion with the three most commonly used femoral stems used at out institution. While we acknowledge that no femoral stem is immune to corrosion, certain femoral stem designs may be uniquely resistant to this mode of failure. Level of Evidence III.

Quantification of trunnion damage in a series of intact total hip arthroplasty femoral stems previously identified to be at risk of catastrophic failure

“…2,[11][12][13] As such, surgeon efforts to minimise the risk of trunnionosis are largely limited to implant selection, fuelling numerous implantspecific clinical and retrieval studies that have highlighted discrepancies in prosthesis performance with respect to head-neck corrosion. 4,14,15 Prior studies have identified a femoral component design from a single manufacturer with an increased propensity for gross trunnion failure (Figure 1). [16][17][18][19][20][21][22][23][24] These events involve either fracture of the trunnion or dissociation of femoral head from the trunnion (Table 1).…”

“…2,11–13 As such, surgeon efforts to minimise the risk of trunnionosis are largely limited to implant selection, fuelling numerous implant-specific clinical and retrieval studies that have highlighted discrepancies in prosthesis performance with respect to head-neck corrosion. 4,14,15…”