Metal-on-Metal Local Tissue Reaction Is Associated With Corrosion of the Head Taper Junction

Fricka, Kevin B.; Ho, Henry; Peace, William J.; Engh, C. Anderson

doi:10.1016/j.arth.2012.03.019

Cited by 98 publications

(73 citation statements)

References 20 publications

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“…Collier et al [8], in a cohort of 411 modular prostheses, reported a positive correlation between corrosion and length of implantation, although the bearing combinations (eg, MoM and MoP) were not reported. Similar results were reported for MoM cohorts [14,20]. Interestingly, Goldberg et al [19] found that although corrosion of the head and neck increased with time, head fretting actually decreased, an effect attributed to etching or buildup of corrosion debris.…”

Section: Discussionsupporting

confidence: 70%

“…Femoral head size has been associated with the severity of fretting and corrosion at the junction with ultralarge ([ 36 mm) MoM THAs, which were used for the advantages of greater ROM and decreased dislocation risk [1,3,14,20,26,29]. Larger heads produce increased rotational and bending moments at the junction and can increase micromotion between the junction contact surfaces [20].…”

Section: Clinical Orthopaedics and Related Researchmentioning

confidence: 99%

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Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties

Triantafyllopoulos

Elpers

Burket

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Fretting and corrosion at head-neck junctions of total hip arthroplasties (THAs) have been associated with adverse local tissue reactions in patients with both metal-onpolyethylene (MoP) and metal-on-metal (MoM) prostheses. Femoral head size contributes to the severity of fretting and corrosion in large-diameter MoM THAs, but its impact on such damage in MoP THAs remains unknown. Questions/purposes (1) Is femoral head size associated with increased fretting or corrosion at the head-neck junction in MoP total hips? (2) Is duration of implantation associated with increased fretting or corrosion? Methods The severity of fretting/corrosion on surfaces of head tapers and stem trunnions was visually examined in 154 MoP THAs retrieved as part of 3282 revision surgeries performed at our institution between January 1, 2007, and December 31, 2013. Fretting and corrosion damage were subjectively graded by two independent observers on a 1 to 4 scale, and their relations to head size, alloy combinations, taper/trunnion design, length of implantation (LOI), and location were investigated. Differences in scores never exceeded one grade, and this occurred in only 17% of examined implants. With the available implants, the study provided 88% power to detect differences of 0.5 in fretting or corrosion scores in these analyses. Results Fretting and corrosion of the tapers and the trunnions were not affected by head size (p = 0.247, p = 0.471, p = 0.837, and p = 0.868, respectively), although taper/trunnion design affected taper fretting (p = 0.005) and corrosion (p = 0.0031) and trunnion fretting (p = 0.0028). Head taper fretting (observed in 73% of heads) increased with LOI, but head taper corrosion (noted in 93% of heads) was not affected. Trunnion fretting (observed in 86% of stems) was more severe in mixed-alloy combinations and with increased LOI and was more severe proximally. Trunnion corrosion (noted in 72% of stems) was also location-dependent with greater corrosion distally. Conclusions Fretting and corrosion are regular occurrences in MoP THAs, but neither damage type was related to femoral head size. Conversely, taper design, LOI, and alloy combination affected the severity of both fretting and corrosion.

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Section: Discussionsupporting

confidence: 70%

Section: Clinical Orthopaedics and Related Researchmentioning

confidence: 99%

Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties

Triantafyllopoulos

Elpers

Burket

et al. 2016

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

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“…Recent implant retrieval studies have indicated the presence of corrosion at the stem-head junction of large-diameter implants [24]. Micromotion toggle caused by a force medial to the centre of the trunnion, made worse by a longer moment arm and increased frictional torque generated at the bearing surface, is thought to be the mechanism behind increasing wear and corrosion noted with increasing head size [10].…”

Section: Discussionmentioning

confidence: 99%

The Role of Metal-on-Metal Bearings in Total Hip Arthroplasty and Hip Resurfacing

Sands

Schemitsch

2016

HSS Jrnl

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Background: The current role of metal-on-metal (MoM) bearings in hip arthroplasty remains controversial. The low wear offered by MoM bearings compared to metalon-polyethylene and the possibility of a lower risk of dislocation with larger head sizes, encouraged a trend towards the re-introduction of the MoM bearing couple. However, recent evidence has shown that not all designs of the MoM bearing have been successful. Questions/Purposes: The purpose of this paper is to provide an update on the use of MoM bearings and address the following issues: (1) the reintroduction of metal-on-metal bearings in total hip arthroplasty, (2) the failure of metal-on-metal bearings in stemmed total hip arthroplasty, (3) the role of metal-on-metal hip resurfacing in modern orthopaedics and (4) metal-on-metal hip resurfacing versus total hip arthroplasty. Methods: A literature search strategy was conducted using various search terms in MEDLINE and Embase. The highest quality articles that met the inclusion criteria and best answered the topics of focus of this review were selected. Key search terms included 'metal-on-metal', 'total hip arthroplasty' and 'hip resurfacing'. Results: The initial search retrieved 1240 articles. Twenty-two articles were selected and used in the review. Conclusion: Metal-on-metal hip resurfacing is still a suitable treatment option in specific patient populations with the appropriate implant design and surgical skill, while stemmed metal-on-metal total hip arthroplasty should be avoided in all patient populations. Continued follow-up of patients undergoing metal-on-metal hip resurfacing is critical in order to further understand the long-term outcomes of these patients and why certain complications tend to occur with this procedure.

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“…The taper interface has been identified in a number of studies [4][5][6][7][8][9][10]25] as a source of wear and corrosion products and there have been identified increased blood ion levels in patients with LHMoM compared to resurfacing bearings [11,18]. Fretting, corrosion and metallic debris have been identified at the taper interface during revision surgery and in several studies [6][7][8][9].…”

Section: Figurementioning

confidence: 99%

Assessing the material loss of the modular taper interface in retrieved metal-on-metal hip replacements

Bills

Răcăşăn

Tessier

et al. 2015

Surf. Topogr.: Metrol. Prop.

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Abstract. Measuring the amount of material loss in the case of revised hip replacements is considered to be a prerequisite of understanding and assessing the true in vivo performance of the implant. This paper outlines a method developed by the authors for quantifying taper material loss as well as more general taper interface parameters. Previous studies have mostly relied on visual inspection to assess the material loss at the taper interface, whereas this method aims to characterize any surface and form changes through the use of an out-of-roundness measurement machine. Along with assessing the volumetric wear, maximum linear penetration and taper contact length can also be determined. The method was applied to retrieved large head metal-on-metal femoral heads in order to quantify the material loss at this junction. Material loss from the female femoral head taper can be characterized as a localized area that is in contact with the stem taper surface. The study showed that this method has good repeatability and a low level of interoperability variation between operators.

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Metal-on-Metal Local Tissue Reaction Is Associated With Corrosion of the Head Taper Junction

Cited by 98 publications

References 20 publications

Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties

Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties

The Role of Metal-on-Metal Bearings in Total Hip Arthroplasty and Hip Resurfacing

Assessing the material loss of the modular taper interface in retrieved metal-on-metal hip replacements

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