Adapter sleeves are essential for ceramic heads in hip revision surgery

Falkenberg, Adrian; Dickinson, Emilie C.; Morlock, Michael M.

doi:10.1016/j.clinbiomech.2019.10.018

Cited by 12 publications

(8 citation statements)

References 18 publications

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“…This confirms the hypothesis that the presence of the sleeve improves the stress-strain state of the ceramic head [16]. But in the investigated case of the head design, the problem is posed and considered not only the above improvement of the stress-strain state, but also, mainly, the eliminating of possible destruction the ceramics under excessive loads.…”

Section: Resultssupporting

confidence: 76%

“…But the use of such a sleeve is mainly recommended for revision prosthetics for fixing the head on the stem, which is well-fixed in the femur and does not require its extraction, and the neck of which has mechanical damage [12][13][14][15]. In [16], a numerical analysis of a sleeve connection with a ceramic head was carried out, which shows an improvement in the stress-strain state of ceramics in the case of using a sleeve. But on the other hand, it was shown in [17] that during the operation of the THR there are micro displacements of the sleeve, both rotational and translational, in the hole of the head and on the stem neck.…”

Section: Introductionmentioning

confidence: 99%

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The Ceramic Modular Head Improvement in the Design of a Total Hip Replacement

2021

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For the first time, a design of a modular ceramic ball head of a total hip joint replacement (THR) friction pair has been developed, which has the properties of a metal in conjunction with the stem neck and the properties of a ceramics on bearing surface of the pair. This is achieved by creating a low-cost, low-toxic, durable fixed connection of the head made of alumina or zirconia ceramics and the titanium-based alloy sleeve to obtain a brazed joint that is efficient in human synovial fluid. With the help of finite element analysis, a quantitative assessment of the strength and rigidity of the proposed head design was performed and its use in modern hip arthroplasty was indicated. The approbation of the proposed design solutions for creating a THR ceramic head with a titanium-based alloy sleeve brazed was carried out.

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Section: Resultssupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

The Ceramic Modular Head Improvement in the Design of a Total Hip Replacement

2021

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“…Kim et al postulated that 36 mm ceramic heads can be used in revision surgery without adapter sleeves [42]. However, despite the adequate head fixation on damaged tapers in our experimental tests, we recommend the use of adapter sleeves, which are known to reduce the ceramic fracture risk [43,44].…”

Section: Discussionmentioning

confidence: 67%

Influence of Different Damage Patterns of the Stem Taper on Fixation and Fracture Strength of Ceramic Ball Heads for Total Hip Replacement

Vogel

Hembus

Jackszis

et al. 2020

BioMed Research International

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Background. Modularity finds frequent application in total hip replacement, allowing a preferable individual configuration and a simplified revision by retaining the femoral stem and replacing the prosthetic head. However, micromotions within the interface between the head and the stem taper can arise, resulting in the release of wear debris and corrosion products. The aim of our experimental study was to evaluate the influence of different taper damages on the fixation and fracture stability of ceramic femoral heads, after static and dynamic implant loading. Methods. Ceramic ball heads (36 mm diameter) and 12/14 stem tapers made of titanium with various mild damage patterns (intact, scratched, and truncated) were tested. The heads were assembled on the taper with a quasistatic load of 2 kN and separated into a static and a dynamic group afterwards. The dynamic group (n=18) was loaded over 1.5 million gait cycles in a hip wear simulator (ISO 14242-1). In contrast, the static group (n=18) was not mechanically loaded after assembly. To determine the taper stability, all heads of the dynamic and static groups were either pulled off (ASTM 2009) or turned off (ISO 7206-16). A head fracture test (ISO 7206-10) was also performed. Subsequent to the fixation stability tests, the taper surface was visually evaluated in terms of any signs of wear or corrosion after the dynamic loading. Results. In 10 of the 18 cases, discoloration of the taper was determined after the dynamic loading and subsequent cleaning, indicating the first signs of corrosion. Pull-off forces as well as turn-off moments were increased between 23% and 54% after the dynamic loading compared to the unloaded tapers. No significant influence of taper damage was determined in terms of taper fixation strength. However, the taper damage led to a decrease in fracture strength by approximately 20% (scratched) and 40% (truncated), respectively. Conclusion. The results suggest that careful handling and accurate manufacturing of the stem taper are crucial for the ceramic head fracture strength, even though a mild damage showed no significant influence on taper stability. Moreover, our data indicate that a further seating of the prosthetic head may occur during daily activities, when the resulting hip force increases the assembly load.

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“…Whether or not the femoral stem can be retained, however, is dictated by the condition of the trunnion at the time of surgery [30] . A trunnion with excessive corrosion may not accept a new ceramic femoral head [30] , and placement of a ceramic head on a suboptimal stem taper surface may, through the creation of nonuniform contact, result in significantly increased tensile stresses [31] , [32] . Owing to their inherently brittle nature, ceramic components are susceptible to rapid crack dissemination, particularly when a trauma exceeds their tensile strength [33] .…”

Section: Discussionmentioning

confidence: 99%

“…Surface topography, time in situ, trunnion length, and material can all impact trunnion damage seen at the time of revision. Owing to the inability to pinpoint an exact cause of trunnion damage, it may be best to assume the presence of damage in all cases and use a titanium-sleeved ceramic head [31] . The fractured femoral head was sent to the company for further evaluation; despite multiple attempts to obtain pictures and a further analysis of the head, as of the writing of this article, the company has not responded to our queries.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic intraoperative failure of a ceramic femoral head

2021

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Approximately 17 years after a primary metal-on-metal total hip arthroplasty, a 59-year-old female developed pain, swelling, and weakness in her right hip accompanied by laboratory findings and imaging suggestive of an adverse local tissue reaction. Acetabular revision was performed to upsize the femoral head and improve hip stability. Upon impaction of the new, non-option ceramic femoral head onto the unsleeved retained stem, the head split into two pieces without fragmentation. The surgery was completed using a cobalt-chromium head, which was impacted without issue onto the stem's taper. Although BIOLOX delta femoral heads do not require titanium sleeves, we believe that careful consideration should be given to their use in revision total hip arthroplasty with ceramic heads, regardless of the extent of trunnion damage noted intraoperatively.

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Adapter sleeves are essential for ceramic heads in hip revision surgery

Cited by 12 publications

References 18 publications

The Ceramic Modular Head Improvement in the Design of a Total Hip Replacement

The Ceramic Modular Head Improvement in the Design of a Total Hip Replacement

Influence of Different Damage Patterns of the Stem Taper on Fixation and Fracture Strength of Ceramic Ball Heads for Total Hip Replacement

Catastrophic intraoperative failure of a ceramic femoral head

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