Nano-analyses of wear particles from metal-on-metal and non-metal-on-metal dual modular neck hip arthroplasty

Xia, Zhidao; Ricciardi, Benjamin F.; Liu, Zhao; Ruhland, Christopher John Von; Ward, M. B.; Lord, Alex M.; Hughes, Lorna; Goldring, Steven R.; Purdue, Ed; Murray, David; Perino, Giorgio

doi:10.1016/j.nano.2016.11.003

Cited by 70 publications

(62 citation statements)

References 53 publications

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“…We observed particles with similar compositions inside the head–neck junction (Figure a,b), showing the link of this type of particles with fretting corrosion at head–neck junction. Previous studies also observed similar particles in tissues from MoM hip resurfacing (without head–neck junction; Catelas, Medley, Campbell, Huk, & Bobyn, ; Goode et al, ; Xia et al, ). It suggested tribocorrosion at articulating surfaces could release similar chromium oxide particles into the peri‐implant environment.…”

Section: Discussionsupporting

confidence: 53%

CoCrMo metal release in metal‐on‐highly crosslinked polyethylene hip implants

et al. 2019

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Increasing cases of adverse local tissue reactions (ALTRs) associated with metal release have been observed in patients with metal‐on‐highly crosslinked polyethylene (MoP) hip implants, the most common design in total hip replacements. Studies have demonstrated the metal release from fretting corrosion at the head–neck junction, but rarely investigated tribocorrosion associated metal release at articulating surfaces in MoP hip implants. The objective of this study is to investigate both tribocorrosion at the articulating surfaces and fretting corrosion at the head–neck junction in CoCrMo femoral heads, as well as their association with metal species released in periprosthetic tissues and body fluids in MoP hip systems. Twenty‐three patients with ALTRs associated with MoP implants were included. Systematic analyses were performed on the wear damage in articulation, corrosion at the head–neck junction and their correlation with degradation products observed in synovial fluid, periprosthetic tissues, and serum. Results showed that tribocorrosion at the articulating surfaces contributed to the elevated concentration of both Co and Cr ions in serum, while fretting corrosion at the head–neck junction mainly released Co ions to serum. Both tribocorrosion at the articulating surfaces and fretting corrosion at the head–neck junction released particles rich in chromium and phosphate, the dominant particles found in synovial fluids and tissues. This study provides strong evidence that tribocorrosion at the articulating surfaces in MoP hip implants could result in significant metal release. This information should be taken into account when studying the mechanisms of ALTRs and developing strategies of preventing metal release in total hip replacements.

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Section: Discussionsupporting

confidence: 53%

CoCrMo metal release in metal‐on‐highly crosslinked polyethylene hip implants

et al. 2019

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“…Corrosive and nano-sized wear byproducts from metallic implants also contribute to the adverse reaction to particulate debris [34][35][36]. At least one research group also reported the inflammatory cell-induced corrosion of TKAs [37].…”

Section: Stimuli Of Periprosthetic Inflammationmentioning

confidence: 99%

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

Goodman

Gallo

2019

JCM

166

163

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Clinical studies, as well as in vitro and in vivo experiments have demonstrated that byproducts from joint replacements induce an inflammatory reaction that can result in periprosthetic osteolysis (PPOL) and aseptic loosening (AL). Particle-stimulated macrophages and other cells release cytokines, chemokines, and other pro-inflammatory substances that perpetuate chronic inflammation, induce osteoclastic bone resorption and suppress bone formation. Differentiation, maturation, activation, and survival of osteoclasts at the bone–implant interface are under the control of the receptor activator of nuclear factor kappa-Β ligand (RANKL)-dependent pathways, and the transcription factors like nuclear factor κB (NF-κB) and activator protein-1 (AP-1). Mechanical factors such as prosthetic micromotion and oscillations in fluid pressures also contribute to PPOL. The treatment for progressive PPOL is only surgical. In order to mitigate ongoing loss of host bone, a number of non-operative approaches have been proposed. However, except for the use of bisphosphonates in selected cases, none are evidence based. To date, the most successful and effective approach to preventing PPOL is usage of wear-resistant bearing couples in combination with advanced implant designs, reducing the load of metallic and polymer particles. These innovations have significantly decreased the revision rate due to AL and PPOL in the last decade.

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“…In a nano-analysis of wear particles from retrieved peri-prosthetic tissue, Xia et al [60] could clearly distinguish between metal-on-metal (MoM) surface replacement (n = 12; implantation time 51.6 months), MoM large head THA (n = 18; implantation time 59.9 months) and non-MoM dual modular neck hip arthroplasty (Rejuvenate) (n = 23; implantation time 30.9 months). They found that the particle physical characteristics and metal composition are consistent in each implant category and concluded that substantial differences in size, shape and element composition of the metallic particles correlate with the histological features of severity of ALTR and variability in implant performance, indicating that the immunogenicity and toxicity of the released particles is a leading factor in the specific onset and severity of the reaction [60,61].…”

Section: Literature On Symptomatic and Asymptomatic Dual Taper Hip Stemsmentioning

confidence: 99%

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

Grupp

Baxmann²,

Jansson

et al. 2020

Materials

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How to proceed with a clinically asymptomatic modular Metha® Ti alloy stem with dual taper CoCr neck adapter in case of acetabular revision? To systematically answer this question the status of research and appropriate diagnostic methods in context to clinically symptomatic and asymptomatic dual taper stem-neck couplings has been evaluated based on a systematic literature review. A retrieval analysis of thirteen Metha® modular dual taper CoCr/Ti alloy hip stems has been performed and a rational decision making model as basis for a clinical recommendation was developed. From our observations we propose that in cases of acetabular revision, that for patients with a serum cobalt level of > 4 µg/L and a Co/Cr ratio > 3.6, the revision of the modular dual taper stem may be considered. Prior to acetabular revision surgery a systematic diagnostic evaluation should be executed, using specific tests such as serum metal (Co, Cr) ion analysis, plain antero-posterior and lateral radiographs and cross-sectional imaging modalities (Metal Artefact Reduction Sequence Magnetic Resonance Imaging). For an asymptomatic Metha® dual taper Ti alloy/CoCr stem-neck coupling at the stage of acetabular revision careful clinical decision making according to the proposed model should be followed and overreliance on any single examination should be avoided, considering the complete individual differential diagnosis and patient situation.

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Nano-analyses of wear particles from metal-on-metal and non-metal-on-metal dual modular neck hip arthroplasty

Cited by 70 publications

References 53 publications

CoCrMo metal release in metal‐on‐highly crosslinked polyethylene hip implants

CoCrMo metal release in metal‐on‐highly crosslinked polyethylene hip implants

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

How to Proceed with Asymptomatic Modular Dual Taper Hip Stems in the Case of Acetabular Revision

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