Bi-modular hip arthroplasty prostheses allow adaptation to the individual patient anatomy and the combination of different materials but introduce an additional interface, which was related lately to current clinical issues. Relative motion at the additional taper interface might increase the overall risk of fretting, corrosion, metallic debris and early failure. The aim of this study was to investigate whether the assembly force influences the relative motion and seating behaviour at the stem-neck interface of a bi-modular hip prosthesis (Metha(®); Aesculap AG, Tuttlingen, Germany) and whether this relation is influenced by the taper angle difference between male and female taper angles. Neck adapters made of titanium (Ti6Al4V) and CoCr (CoCr29Mo) were assembled with a titanium stem using varying assembly forces and mechanically loaded. A contactless eddy current measurement system was used to record the relative motion between prosthesis stem and neck adapter. Higher relative motion was observed for Ti neck adapters compared to the CoCr ones (p < 0.001). Higher assembly forces caused increased seating distances (p < 0.001) and led to significantly reduced relative motion (p = 0.019). Independent of neck material type, prostheses with larger taper angle difference between male and female taper angles exhibited decreased relative motion (p < 0.001). Surgeons should carefully use assembly forces above 4 kN to decrease the amount of relative motion within the taper interface. Maximum assembly forces, however, should be limited to prevent periprosthetic fractures. Manufacturers should optimize taper angle differences to increase the resistance against relative motion.

Modular hip implants are at risk of fretting-induced postoperative complications most likely initiated by micromotion between adjacent implant components. A stable fixation between ball head and stem-neck taper is critical to avoid excessive interface motions. Therefore, the aim of this study was to identify the effect of trunnion roughness and length on the modular taper strength under typical intraoperative assembly forces. Custom-made Titanium trunnions (standard/mini taper, smooth/grooved surface finish) were assembled with modular Cobalt-chromium heads by impaction with peak forces ranging from 2kN to 6kN. After each assembly process these were disassembled with a materials testing machine to detect the pull-off force as a measure for the taper strength. As expected, the pull-off forces increased with rising peak assembly force (p < 0.001). For low and moderate assembly forces, smooth standard tapers offered higher pull-off forces compared to grooved tapers (p < 0.038). In the case of an assembly force of 2kN, mini tapers showed a higher taper strength than standard ones (p=0.037). The results of this study showed that smooth tapers provided a higher strength for taper junctions. This higher taper strength may reduce the risk of fretting-related complications especially in the most common range of intraoperative assembly forces.