Titanium neck-titanium stem taper corrosion in a modular neck stem

Abstract

An 81-year-old woman presented with progressive groin pain after metal-on-polyethylene total hip arthroplasty with a modular neck stem and was found to have adverse local tissue reaction. As we report for the first time with this implant, we observed titanium neck-titanium stem taper corrosion intraoperatively. We also found head-neck taper corrosion. The patient underwent revision surgery to a modular fluted tapered stem with ceramic head and was asymptomatic at 3-year follow-up visit. In conclusion, consideration should be given to avoiding the routine use of this modular neck stem in total hip arthroplasty. Patients with this prosthesis should be closely monitored for adverse local tissue reaction.

Unexpected varus deformity and concomitant metal ion release and MRI findings of modular-neck hip stems: descriptive RSA study in 75 hips with 8 years’ follow-up

“…Taper corrosion at the modular junctions of THA femoral stems are known to cause ALTR (Lindgren et al 2011. Revisions as a consequence of ALTR associated with neck-stem taper corrosion have now been reported (Nahhas et al 2019, Shah et al 2019 and should be considered as a potential cause for progressive, disabling groin pain (Cooper et al 2013).…”

Disassociation of a Cold-Welded Bimodular Titanium Femoral Stem by Intraoperative Ice Cooling

“…Although bimodular hip implants historically have had a poor track record, this particular stem has not been recalled, and modular titanium neck implants were available and ready for this case. While there have been a number of case reports of MACC at the head-neck junction of this specific 12/14 taper when used with cobalt-chromium heads, there has only been a single case report of possible MACC at the titanium-titanium stem-neck taper junction with this stem [25]. In this one case report, the presumed crevice corrosion seen was the black corrosion product seen on the modular neck at the neck-stem interface near the exposed shoulder of the neck, while the patient had obvious MACC at the head-neck junction with black corrosion products all around that male taper along with elevated cobalt and chromium ion levels while having undetectable titanium ion levels.…”

Letter to the Editor on “Disassociation of a Cold-Welded Bimodular Titanium Femoral Stem by Intraoperative Ice Cooling”

“…Their unique technical solution should be remembered by all revision surgeons, and I agree with their logical approach to the difficult decision-making of when to remove a well-positioned, well-fixed, bimodular titanium femoral stem. I agree that current information about the Zimmer M/L taper prosthesis with Kinectiv Technology (Zimmer Biomet, Warsaw, IN) makes it a candidate for partial revision because (1) the neck is constructed of titanium (Ti) alloy, and although a Ti-Ti interface with the stem may cold-weld [ 1 ] or even corrode [ 2 , 3 ], it will likely not lead to an adverse local tissue reaction as there is no cobalt (Co) alloy involved; (2) the design length of this particular modular titanium neck is relatively short and therefore unlikely to break, distinct from longer Ti modular necks that are apt to fracture [ 4 , 5 ]; and (3) usage of a ceramic femoral head at the obverse taper on the neck should diminish corrosion and metal loss [ 6 ], and again, without a Co-alloy component in the mix, minimize the risk of adverse local tissue reactions. The decision to revise such a stem is complex [ 7 ], but the authors make a very logical argument for revising only the head and neck in their patient’s case.…”