Micromotions at the taper interface between stem and neck adapter of a bimodular hip prosthesis during activities of daily living

Jauch, S.Y.; Huber, Gerd; Sellenschloh, Kay; Haschke, Henning; Baxmann, M.; Grupp, Thomas M.; Morlock, Michael M.

doi:10.1002/jor.22354

Cited by 44 publications

(18 citation statements)

References 32 publications

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“…2). Micromotion at the neck-stem junction results in abrasion and fretting corrosion [17,18]. Chemomechanical stress is reported to be higher in titanium modular necks compared with cobalt-chromium bimodular necks.…”

Section: Discussionmentioning

confidence: 99%

High Risk of Failure With Bimodular Femoral Components in THA

Pour

Borden

Murayama

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The bimodular femoral neck implant (modularity in the neck section and prosthetic head) offers several implant advantages to the surgeon performing THAs, however, there have been reports of failure of bimodular femoral implants involving neck fractures or adverse tissue reaction to metal debris. We aimed to assess the results of the bimodular implants used in the THAs we performed. Questions/purposes We asked: (1) What is the survivorship of the PROFEMUR 1 bimodular femoral neck stems? (2) What are the modes of failure of this bimodular femoral neck implant? (3) What are the major risk factors for the major modes of failure of this device?Methods Between 2003 and 2009, we used one family of bimodular femoral neck stems for all primary THAs (PRO-FEMUR 1 Z and PROFEMUR 1 E). During this period, 277 THAs (in 242 patients) were performed with these implants. One hundred seventy were done with the bimodular PROFE-MUR 1 E (all are accounted for here), and when that implant was suspected of having a high risk of failure, the bimodular PROFEMUR 1 Z was used instead. One hundred seven THAs were performed using this implant (all are accounted for in this study). All bearing combinations, including metal-on-metal, metal-on-polyethylene, and ceramic-on-ceramic, are included here. Data for the cohort included patient demographics, BMI, implant dimensions, type of articular surface, length of followup, and C-reactive protein serum level. We assessed survivorship of the two stems using Kaplan-Meier curves and determined the frequency of the different modes of stem failure. For each of the major modes of failure, we performed binary logistic regression to identify associated risk factors. Results Survivorship of the stems, using aseptic revision as the endpoint, was 85% for the patients with the PROFE-MUR 1 E stems with a mean followup of 50 months (range, 1-125 months) and 85% for the PROFEMUR 1 Z with a mean followup of 50 months (range, 1-125 months)(95% CI, 74-87 months). The most common modes of failure were loosening (9% for the PROFEMUR 1 E), neck fracture (6% for the PROFEMUR 1 Z and 0.6% for the PROFEMUR 1 E), metallosis (1%), and periprosthetic fracture (1%). Only the bimodular PROFEMUR 1 E was associated with femoral stem loosening (odds ratio [OR] =1.1; 95% CI, 1.04-1.140; p = 0.032). Larger head (OR = 3.2; 95% CI, 0.7-14; p = 0.096), BMI (OR = 1.19; 95% CI, 1-1.4; p = 0.038) and total offset (OR = 1.83; 95% CI, 1.13-2.9; p = 0.039) were associated with neck fracture.

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Section: Discussionmentioning

confidence: 99%

High Risk of Failure With Bimodular Femoral Components in THA

Pour

Borden

Murayama

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The magnitude of micromotion has been reported to be influenced by factors such as design parameters [17,18] and the load level during a load cycle [28]. The latter study estimated the quantity of micromotion in the taper interface between stem and neck adapter of a bimodular hip prosthesis.…”

Section: Discussionmentioning

confidence: 99%

Are asymmetric metal markings on the cone surface of ceramic femoral heads an indication of entrapped debris?

Valet

Weisse

Kuebler

et al. 2014

BioMedical Engineering OnLine

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BackgroundThe probability of in vivo failure of ceramic hip joint implants is very low (0.004-0.05%). In addition to material flaws and overloading, improper handling during implantation can induce fractures of the ceramic ball head in the long term. Identifying the causes of an in vivo fracture contributes to improved understanding and potentially to further reduction of the fracture probability for patients. Asymmetric metal markings on the cone surface of in vivo ball head fractures have been reported. The question, therefore, is whether asymmetric loading is the sole cause or whether additional factors, specifically contamination entrapped in the taper fit, also contribute or are even the main cause.MethodsThe influence of the asymmetric physiological load configuration on resulting metal markings in the cone surface of an alumina femoral ball head with and without biological contaminants was investigated. Static and cyclic tests on ball heads were carried out in a load configuration of 0° (axisymmetric) and 40° in a physiological environment. The analysis of the metal marking was carried out to gain a better understanding of the processes that contribute to the generation of metal marking. Fractography was carried out to determine the fracture initiation of failed ball heads.ResultsDifferent types and sizes of residuals entrapped in the conical surface are shown to yield strongly asymmetric metal marking patterns. All heads tested without contaminants exhibited an almost homogenous distribution of residual metal markings around the circumference of the ceramic cone surface at the proximal end of the bore hole. The failure of ball heads that contained entrapped contaminants revealed a common fracture pattern. The site of fracture initiation on two of the failed heads was in the entrance region of the bore hole on the superior half of the head.ConclusionAsymmetric metal markings observed on the ball heads tested in this investigation are most probably caused by the presence of contaminants entrapped in the taper fit. Homogenous metal mark distributions around the circumference indicate proper assembly of the ball head without entrapped contaminants. It should, however, be noted that different taper designs may possibly result in different marking patterns.

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“…Not all pristine sizes were available for comparison since Accolade I stems are no longer on the market. For this reason, the original neck and taper volumes of all GTF stems were estimated based on the volume of the respective four available stem sizes (3,4,5,8). A linear regression model of stem offset and neck length was fitted to the measured volumes.…”

Section: Explant Analysismentioning

confidence: 99%

“…It is widely acknowledged that any modular connection between metal alloys can exhibit corrosion problems if in contact with body fluids and exposed to micromotion [4;5]. The magnitude of micromotion during in-vivo loading is mainly influenced by 3 factors: the taper design and material [6], the assembly condition [7], and the loading magnitude and direction [8]. It was shown early on that low neck stiffness is a contributing factor [4].…”

Section: Introductionmentioning

confidence: 99%