The Surgical Options and Clinical Evidence for Treatment of Wear or Corrosion Occurring With THA or TKA

Abstract

Background Wear and corrosion occurring in patients with hip and knee arthroplasty are common causes of failure leading to revision surgery. A variety of surgical approaches to these problems have been described, with varying efficacy. Polyethylene wear, metal-on-metal (MoM) hip bearing wear, and problems associated with modular taper corrosion are the areas of greatest clinical impact; results of revisions for these problems are likely to dictate a large portion of revision resources for the foreseeable future, and so they call for specific study. Questions/purposes We identified the most frequently reported procedures to treat hip polyethylene wear, knee polyethylene wear, MoM wear after THA, and modular taper corrosion and determined the timing and reasons these failed. Methods We performed systematic reviews of the published literature on the four topics using MEDLINE 1 and Embase in October 2013; searches were supplemented by hand searches of bibliographies. Prespecified criteria resulted in the identification of 38 relevant articles, of which 33 were either case reports or Level IV evidence. Followup was generally at short term and ranged from 0.2 to 8 years. Results The most frequently reported procedures for treating clinically important wear were a partial or complete revision. When treating polyethylene wear, the more frequently reported reasons for hip and knee rerevisions were loosening, continued wear, and instability. Soft tissue reactions were more common and occasionally extensive in patients with MoM or modular taper corrosion. Patients with soft tissue reactions had more complications and higher rerevision rates. Conclusions Studies with longer followup and higher levels of evidence are needed to direct the treatment of wear and corrosion. When soft tissue damage secondary to MoM wear or taper corrosion is present, the results of treatment can be poor. There is an urgent need to better understand these two mechanisms of failure.

Head-Neck Taper Corrosion in Hip Arthroplasty

“…Although modular hips were introduced in the 80s and taper corrosion was reported in the early 90s, the contribution of fretting and corrosion at the taper junction [ 51 , 65 ] to implant failure is now being increasingly recognised. The severity of early corrosion-related failure of modular femoral stem-neck junction is a potential reason for concern [ 66 ], and the surgeon should be aware of the potential drawbacks of modularity in THA.…”

Trunnionosis in Total Knee Arthroplasty: Is it a clinical problem?

“…There are simply many more examples of THA trunnionosis to observe and collect data on. However, while this may be true there is at least some evidence that the prevalence of trunnionosis in TKA may be larger than currently reported [23][24][25][26][27][28] . The underreporting of trunnionosis in TKA only amplifies the growing disparity in the literature regarding trunnionosis in TKA vs THA.…”

“…The treatment for trunnionosis in TKA is similar to that of THA [18] . The prosthetic removal, the soft tissue debridement for those regions affected by ARMD, and the subsequent revision is the mainstay of treatment [4,23,24] .…”

“…This overdiagnosis becomes a concern in the asymptomatic patient with elevated levels of metal ions in the blood [12] . Currently there is debate on whether or not to systematically monitor blood levels for elevated metal ions [12,23] . The long-term benefit of this monitoring has yet to be established, but it may be a useful method to initiate closer follow up in both THA and TKA patients [12] .…”

Severe Polyethylene Wear Requiring Revision Total Hip Arthroplasty in Three Dogs

“…Furthermore, a THA in a dog with significant morbidity associated with other limbs likely results in increased loads to the prosthesis, which may be significant. Significant cup wear is a common long‐term complication of human total hip replacements, in that human implants are often expected to last 15 or more years, with a shorter lifespan expected in younger and more active patients . As the duration of implantation in the dog is increased with implantation in younger dogs, similar issues may occur as this cohort of canine patients ages.…”