Patients With Modular-Neck Total Hip Arthroplasty: A Brief Five-Year Follow-Up Study

Inoue, Dai; Restrepo, Camilo; Nourie, Blake; Restrepo, Santiago; Hozack, William J.

doi:10.1016/j.arth.2020.02.059

Cited by 5 publications

(3 citation statements)

References 16 publications

(20 reference statements)

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“…In patients with unexplained pain that have dual modular implants where the neck is made from CoCr, one may consider an ALTR as a product of mechanically assisted crevice corrosion (MACC) of the neck-stem interface [ 67 ]. A two-year follow-up of 195 hip implants in 183 patients with only moderate elevation in serum Co levels showed abnormal imaging studies in 36%, clinical symptoms in 44%, and revision due to corrosion in 13% of observed hips [ 68 ]; however, at a midterm mean follow-up of 5 years, the prevalence of revision surgery due to corrosion almost doubled [ 69 ]. Early short-term outcomes of the Rejuvenate (Stryker) implant show that the majority (66%) of patients experiencing complications require revision surgery at the end [ 70 ].…”

Section: Resultsmentioning

confidence: 99%

Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches

2021

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Titanium (Ti) alloys have been proven to be one of the most suitable materials for orthopaedic implants. Dual modular stems have been introduced to primary total hip arthroplasty (THA) to enable better control of the femoral offset, leg length, and hip stability. This systematic review highlights information acquired for dual modular Ti stem complications published in the last 12 years and offers a conclusive discussion of the gathered knowledge. Articles referring to dual modular stem usage, survivorship, and complications in English were searched from 2009 to the present day. A qualitative synthesis of literature was carried out, excluding articles referring solely to other types of junctions or problems with cobalt-chromium alloys in detail. In total, 515 records were identified through database searching and 78 journal articles or conference proceedings were found. The reasons for a modular neck fracture of a Ti alloy are multifactorial. Even though dual modular stems have not shown any clinical benefits for patients and have been associated with worse results regarding durability than monolithic stems, some designs are still marketed worldwide. Orthopaedic surgeons should use Ti6Al4V dual modular stem designs for primary THA in special cases only.

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Section: Resultsmentioning

confidence: 99%

Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches

2021

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“…The modular-neck stem of patients consisted of a titanium-molybdenum-zirconia-ferrite alloy stem and a CoCr modular neck. [ 16 ] Serious adverse reactions have been observed in virtually all reported cases of cobalt-based alloys. Furthermore, an in vitro study showed that cobalt is more toxic to macrophages than other metals commonly used in implants.…”

Section: Discussionmentioning

confidence: 99%

Pseudotumor and delayed recurrent dislocation after total hip arthroplasty with a modular femoral neck

Huang¹,

Wang²,

Zhang³

et al. 2022

Medicine

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Rationale: Pseudotumor formation after hip arthroplasty is a rare complication that can occur not only at the head-neck junction but also at the modular neck-stem junction. Dislocation is a challenging and common complication of primary and revision total hip arthroplasty compared with other complications. Similarly, the association between pseudotumors and delayed recurrent dislocation remains unclear.Patient concerns: We report the case of a 73-year-old woman with pseudotumor formation after total hip arthroplasty combined with a modular femoral neck. A delayed recurrent dislocation occurred in this case. Approximately 4 weeks after the first revision surgery, redislocation occurred. Diagnosis:The patient was eventually diagnosed with delayed recurrent artificial hip dislocation combined with a periprosthetic pseudotumor of the right hip.Interventions: During the first revision surgery, a thickened, indurated cyst measuring 8 Â 3 Â 8 cm with a red-brown wall containing brown fluid was completely excised. A cemented stem, combined with a BIOLOX Forte ceramic head, was implanted. Approximately 4 weeks after surgery, redislocation occurred, and we cemented an elevated rim liner on the acetabular component with a metal head.Outcomes: At the last follow-up, 49 months after revision surgery, the patient was asymptomatic with a Harris hip score of 90. The patient had a satisfactory prognosis after treatment.Lessons: The application of the modular-neck stem should be cautiously performed, particularly for modular prostheses containing different alloys. Pseudotumors and insufficient soft-tissue tension both contribute to hip instability, which may eventually lead to delayed repeated dislocation. In addition, femoral offset must be considered. Cement-liner technology may be used for aging patients who are less active. This case report, focusing on pseudotumors and delayed recurrent dislocations, aimed to identify factors that may support this diagnosis, which is easy to miss. Consequently, it can provide further details on the treatment process and alert orthopedic surgeons to this infrequent but important cause of delayed recurrent dislocation.

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“…Furthermore, this failure pattern can trigger biological reactions in response to metallic debris. Possible consequences include toxicity, muscular atrophy, osteolysis and the development of pseudo tumors [4][5][6]. The design of the taper junction should therefore aim to minimize fretting corrosion.…”

Section: Introductionmentioning

confidence: 99%

Short-Term Heat Treatment of Ti6Al4V ELI as Implant Material

et al. 2020

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Due to its mechanical properties and good biocompatibility, Ti6Al4V ELI (extra low interstitials) is widely used in medical technology, especially as material for implants. The specific microstructures that are approved for this purpose are listed in the standard ISO 20160:2006. Inductive short-term heat treatment is suitable for the adjustment of near-surface component properties such as residual stress conditions. A systematic evaluation of the Ti6Al4V microstructures resulting from short-term heat treatment is presently missing. In order to assess the parameter field that leads to suitable microstructures for load-bearing implants, dilatometer experiments have been conducted. For this purpose, dilatometer experiments with heating rates up to 1000 °C/s, holding times between 0.5 and 30 s and cooling rates of 100 and 1000 °C/s were systematically examined in the present study. Temperatures up to 950 °C and a holding time of 0.5 s led to microstructures, which are approved for medical applications according to the standard ISO 20160:2006. Below 950 °C, longer holding times can also be selected.

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Patients With Modular-Neck Total Hip Arthroplasty: A Brief Five-Year Follow-Up Study

Cited by 5 publications

References 16 publications

Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches

Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches

Pseudotumor and delayed recurrent dislocation after total hip arthroplasty with a modular femoral neck

Short-Term Heat Treatment of Ti6Al4V ELI as Implant Material

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