Trunnion corrosion

Berstock, James R; Whitehouse, Michael R; Duncan, Clivе P.

doi:10.1302/0301-620x.100b1.bjj-2017-0569.r1

Cited by 71 publications

(27 citation statements)

References 62 publications

(73 reference statements)

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“…Furthermore, corrosion at the head-neck junction, as seen here, is known to correlate with elevated metal ion level; however, few reports have demonstrated the extensive elevation in metal ion levels, as seen in our case with Cr of 166.6 ppb (≤1.4 ppb reference range) and Co of 115.5 ppb (≤1.8 ppb reference range), respectively. The levels seen in this case are well above those previously reported in non-fatal cases of metal toxicity [15]. A prior study by Banerjee et al.…”

Section: Discussionsupporting

confidence: 82%

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Total hip replacement failure due to adverse local tissue reaction from both ceramic abrasive wear and trunnion corrosion

Thomas

Prieto

2019

Arthroplasty Today

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The most common sources for metal ions after total hip arthroplasty (THA) are the bearing surface in metal-on-metal articulations and trunnion corrosion. Concomitant dual interface failure is an uncommon complication in metal-on-polyethylene THA. We report an unusual case of a 59-year-old woman with ceramic-on-ceramic THA in 2005, who underwent revision to metal-on-polyethylene THA 4 years later after femoral head fracture. Subsequently, she developed substantial adverse local tissue reaction and significant metal ion elevation and the failure was found to be due to both wear at the bearing surface and corrosion at the head neck junction requiring second revision. Findings included massive adverse local tissue reaction, abductor mechanism destruction, osteolysis, and corrosion damage of the trunnion. Abrasive damage of the trunnion was also noted, but prior abrasion from the original ceramic fracture could not be ruled out. Postoperative course at 14 months demonstrates 95% and 64% reduction in cobalt and chromium levels respectively, with symptom resolution.

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Section: Discussionsupporting

confidence: 82%

“…Metallosis is a well-described complication of MoM hip arthroplasty with a documented incidence of approximately 5% [14] and trunnionosis specifically approaching 2% [15]. However, elevated ion levels are not commonly reported in the setting of hard-on-soft bearing surfaces such as seen here.…”

Section: Discussionmentioning

confidence: 83%

Total hip replacement failure due to adverse local tissue reaction from both ceramic abrasive wear and trunnion corrosion

Thomas

Prieto

2019

Arthroplasty Today

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“…We examined the risk according to the year of primary hip replacement and found that there was no difference according to the year group and therefore we did not further adjust for this. The modular junctions of hip replacements are another potential source of metal ion release [ 16 , 17 , 40 ] with complications secondary to this even observed in implants without bearing surfaces [ 41 ] and in some cases, it is felt that this may contribute more than wear at the bearing surface [ 15 ]. Given the variation of release according to design, implants factors, demographics and materials [ 16 ], we have not been able to fully explore this in our analyses but use non-MoM bearings as a control group for MoM bearings.…”

Section: Discussionmentioning

confidence: 99%

The risk of developing cancer following metal-on-metal hip replacement compared with non metal-on-metal hip bearings: Findings from a prospective national registry “The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man”

et al. 2018

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Background and purposeOver 1 million metal-on-metal hip replacements were implanted. Even well-functioning implants produce wear debris that can cause tissue damage, disseminate and cause DNA damage. We aimed to establish if there was an association between metal-on-metal hip replacement and the risk of subsequently developing cancer compared with alternative hip replacements.MethodsWe performed a population based prospective longitudinal cohort study using data from the National Joint Registry linked to Hospital Episode Statistics (n = 403,881 patients). We examined the incidence of a new diagnosis of cancer in patients who received a metal-on-metal bearing in comparison with those who received a non metal-on-metal bearing. Kaplan-Meier estimates of time to first cancer diagnosis were used with Cox proportional hazards regression models to assess the effect on the time to cancer diagnosis for all cancer types, haematological, malignant melanoma, urinary tract cancers or prostate cancer in men.ResultsThe maximum follow up available was 11.8 years with 25% of patients followed up for more than 6.8 years (mean follow up 4.6 years; median 4.3; IQR 2.1–6.8; range 0.01–11.8). Analyses by gender that adjusted for age at primary and presence or absence of linked Welsh (PEDW) records showed no increase in the risk of developing cancer according to the bearing surface implanted for all cancers, haematological cancers, malignant melanoma, urinary tract cancers or prostate cancer in men. For patients receiving a second hip replacement, there was also no difference.ConclusionWe have demonstrated that there is currently no evidence of an increase in the risk of cancer following primary hip replacement according to the type of bearing material used. Although the risk of revision in metal-on-metal bearing hip replacements is higher, it is reassuring that the risk of a new diagnosis of cancer is not currently increased. Despite the long term follow up available in this study, the latency period for some cancers is very long and therefore continued monitoring is required to ensure no new patterns emerge that may indicate need for universal screening.

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“…However, in the case of clinical problems and no radiologically evident causes (e.g. loosening), it is now recommended to perform metal analysis in the blood [63]. With metal heads, taper problems may elevate the cobalt and chromium levels, some authors consider a serum cobalt level above 1.6 ng/ml or a cobalt level higher than chromium as an indicator of taper damage [64 -66].…”

Section: When?mentioning

confidence: 99%

Metal Ion Release after Hip and Knee Arthroplasty – Causes, Biological Effects and Diagnostics

et al. 2019

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All metal implants in human bodies corrode which results in metal ions release. This is not necessarily a problem and represents for most patients no hazard. However, if a critical metal ion concentration is exceeded, local or rarely systemic problems can occur. This article summarizes the mechanisms of metal ion release and its clinical consequences. Several situations can result in increased metal ion release: metal-on-metal hip arthroplasties with increased wear, increased micromotion at taper interfaces, direct metal-metal contact (polyethylene wear, impingement), erroneously used metal heads after ceramic head fracture. Possible problems are in most cases located close to the concerned joint. Furthermore, there are reports about toxic damage to several organs. Most of these reports refer to erroneously used metal heads in revisions after a broken ceramic head. There is currently no evidence of carcinogenic or teratogenic effects of implants but data is not sufficient to exclude possible effects. Cobalt and chromium blood levels (favorably in whole blood) should be measured in patients with suspected elevated metal ions. According to current knowledge levels below 2 µg/l seem to be uncritical, levels between 2 and 7 µg/l are considered borderline with unknown biological consequences and levels above 7 µg/l indicate a local problem which should be further diagnosed. Metal ion levels always need to be interpreted together with clinical symptoms and imaging results.

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Trunnion corrosion

Abstract: Identifying causative risk factors is challenging due to the multifactorial nature of this problem. Cite this article: 2018;100-B(1 Supple A):44-9.

Cited by 71 publications

References 62 publications

Total hip replacement failure due to adverse local tissue reaction from both ceramic abrasive wear and trunnion corrosion

Total hip replacement failure due to adverse local tissue reaction from both ceramic abrasive wear and trunnion corrosion

The risk of developing cancer following metal-on-metal hip replacement compared with non metal-on-metal hip bearings: Findings from a prospective national registry “The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man”

Metal Ion Release after Hip and Knee Arthroplasty – Causes, Biological Effects and Diagnostics

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