Corrosion Damage and Wear Mechanisms in Long-Term Retrieved CoCr Femoral Components for Total Knee Arthroplasty

Abstract

Background Metal debris and ion release has raised concerns in joint arthroplasty. The purpose of this study was to characterize the sources of metallic ions and particulate debris released from long-term (in vivo > 15y) TKA femoral components. Methods A total of 52 CoCr femoral condyles were identified as having been implanted for more than 15 years. The femoral components were examined for incidence of five types of damage (metal-on-metal wear due to historical polyethylene insert failure, MACC at taper interfaces, cement interface corrosion, third-body abrasive wear, and ICIC). Third-body abrasive wear was evaluated using the Hood method for polyethylene components and a similar method quantifying surface damage of the femoral condyle was used. The total area damaged by ICIC was quantified using digital photogrammetry. Results Surface damage associated with corrosion and/or CoCr debris release was identified in 98% (n=51) of the CoCr femoral components. Five types of damage were identified: 98% of femoral components exhibited 3rd body abrasive wear (mostly observed as scratching, n=51/52), 29% of femoral components exhibited ICIC damage (n=15/52), 41% exhibited cement interface damage (n=11/27), 17% exhibited metal-on-metal wear following wear-through of the polyethylene insert (n=9/52), and 50% of the modular femoral components exhibited MACC taper damage (n=2/4). The total ICIC damaged area was an average of 0.11 ± 0.12 mm2 (Range: 0.01–0.46mm2). Conclusion Although implant damage in TKA is typically reported with regard to the polyethylene insert, the results of this study demonstrate that abrasive and corrosive damage occurs on the CoCr femoral condyle in vivo.

High wear resistance of femoral components coated with titanium nitride: a retrieval analysis

“…Retrieval analyses have received more attention in the last years as these studies have provided an exclusive insight into how wear affects the hard femoral component besides the more softer insert made of different types of polyethylene [2, 14, 17, 24]. Currently, no data exist to explain the sensitivity of TiN-coated TKAs made of CoCrMo with regard to surface damage and wear resistance.…”

Osteoblasts MC3T3-E1 Response in 2D and 3D Cell Cultures Models to High Carbon Content CoCr Alloy Particles. Effect of Metallic Particles on Vimentin Expression

“…Their excellent corrosion resistance relies on the formation of very stable, continuous, highly adherent and protective passive film on the metallic surface (Milosev, 2012). This passive film prevents degradation of the alloys as is one of the kinetic barriers preventing implant corrosion (Arnholt et al, 2016). However, due to wear, electrochemical dissolution, or a combination of the 2 processes, micro and nanometric sizes wear particles are still produced and metallic ions are released from the prosthesis of the implanted patients (Billi et al, 2009;Hosman et al, 2010;Arnholt et al, 2016).…”

“…This passive film prevents degradation of the alloys as is one of the kinetic barriers preventing implant corrosion (Arnholt et al, 2016). However, due to wear, electrochemical dissolution, or a combination of the 2 processes, micro and nanometric sizes wear particles are still produced and metallic ions are released from the prosthesis of the implanted patients (Billi et al, 2009;Hosman et al, 2010;Arnholt et al, 2016). Catelas et al (2003) have reported the necessity to carry out in vitro studies of the effects of these wear particles rather than the effect of CoCrMo particles on tissue response.…”

“…The effects of particles described above on osteoblasts cell response were assessed by 2D and 3D cell cultures. The 2D assay provides mainly information about the events that takes place at the cell-particle interface (Arnholt et al, 2016) and the 3D cell culture is a model considered close to tissue architecture where multiple interactions between cell-cell and cell-extracellular matrix take place, and diffusion and substances transports mechanisms play an important role (Lee et al, 2009). Additionally, 3D cell cultures also create a cellular environment that promotes cellular differentiation and tissues organization that does not occur in 2D cell cultures (Huh, Hamilton, & Ingber, 2011).…”

Inflammatory cell‐induced corrosion in total knee arthroplasty: A retrieval study

“…The mechanisms of metal loss are multifactorial and can include mechanically assisted crevice corrosion (MACC), wear at the bearing surfaces and the recently described phenomenon of inflammatory cell‐induced corrosion (ICIC) . ‐ …”