Retrieval analysis of ceramic-coated metal-on-polyethylene total hip replacements

Abstract

In this study we found evidence of coating loss on metal femoral heads which was associated with increased wear of the corresponding polyethylene acetabular cups.

Retrieval analysis of TiN (titanium nitride) coated knee replacements: Coating wear and degradation in vivo

“…This pattern has been described in conventional mobile bearing knee arthroplasties and is due to the fact that third bodies can easily become entrapped between the congruent flat bearing surfaces of the mobile tibial articulation (Kelly et al, ; Lu et al, ; Teeter, Howard, McCalden, & Naudie, ). Since very few ZrO 2 particles were found in SEM studies, we are strongly convinced that particulate defects and protruding TiN film fragments were most likely the main source of the small, hard debris responsible for coating damage (Khatkar et al, ; Łapaj et al, ; Łapaj, Markuszewski, et al, ). This was evidenced by the presence of comet‐tail marks indicating particle pull‐out, the smooth profile of wear scratches and differences in microscopic morphology of the loaded and non‐weight‐bearing parts of the tibial trays.…”

“…Studies regarding TiNbN coated MoM bearings documented that such wear pattern is caused by submicron coating fragments, while larger debris tend to form grooves with cracking of the TiNbN film (Łapaj et al, ; Łapaj, Markuszewski, et al, ). These papers also demonstrated massive exposure of substrate material after several years in vivo, suggesting that the same would eventually happen within mobile tibial bearings (Khatkar et al, ; Łapaj et al, ; Łapaj, Markuszewski, et al, ). However, it is likely that at least some debris could become embedded in the soft poly liner, which would slow the process down.…”

“…It is very difficult to collect such retrievals because TiN coated implants are not routinely used in large groups of patients (Breugem et al, ; Buechel Sr et al, ; Buechel Sr et al, ; Park et al, ; Thienpont, ; Van Hove et al, ). This is reflected by lack of registry data and a small body of literature regarding Ti(Nb)N coated arthroplasties, and retrieval studies focused on such implants also involved small sample numbers (Bone & Naylor, ; Fabry et al, ; Harman et al, ; Khatkar et al, ; Łapaj et al, ; Łapaj, Markuszewski, et al, ; Malviya et al, ; Raimondi & Pietrabissa, ). An inherent limitation of this, as well as other retrieval studies, is that only prematurely revised components were examined, which do not exactly represent well‐functioning knee replacements (Anderson et al, ; Fabry et al, ; Heyse, Elpers, Nawabi, Wright, & Haas, ).…”

“…However, it is likely that at least some debris could become embedded in the soft poly liner, which would slow the process down. Additionally, samples examined in this study were implanted for a relatively short time, and it is likely that longer use would be required to result in pronounced coating wear (Bone & Naylor, ; Khatkar et al, ). Interestingly, analysis of tibial components demonstrated that early stages of third body wear actually result in polishing of the TiN film, removing some particulate defects or protruding coating fragments.…”

“…There is more data regarding the performance of Ti(Nb)N coatings in total hip replacements (THRs) with most studies reporting good clinical outcomes (Buechel Sr et al, ; Harman et al, ; Khatkar et al, ; Łapaj et al, ; Łapaj, Markuszewski, et al, ; Malviya, Lobaz, & Holland, ; Pappas et al, ; Raimondi & Pietrabissa, ; Weisenburger, Haider, & Garvin, ). Some publications documented gross wear of the coating in vivo, whereas one study indicated good wear resistance, but an inconsistent coating quality and presence of various defects (Harman et al, ; Khatkar et al, ; Łapaj et al, ; Raimondi & Pietrabissa, ). Case reports regarding TiNbN coated metal‐on‐metal (MoM) bearings demonstrated massive coating abrasion in a third body mechanism (Bone & Naylor, ; Łapaj, Markuszewski, et al, ; Weisenburger et al, ).…”