Corrosion-Induced Fracture of a Double-Modular Hip Prosthesis

Atwood, Sara A.; Patten, Eli W.; Bozic, Kevin J.; Pruitt, Lisa A.; Ries, Michael D.

doi:10.2106/jbjs.i.00980

Cited by 139 publications

(93 citation statements)

References 6 publications

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“…Fracture of a modular neck was reported in a 30-year-old man who after uncomplicated surgery fell and fractured the neck [1]. In a comparison of modular-neck arthroplasty and resurfacing prostheses, the serum Co and Cr levels were 10 times and 2.6 times higher, respectively, in the modular-neck devices, likely due to pitting corrosion of the taper [11].…”

Section: Introductionmentioning

confidence: 99%

“…Several case reports have reported difficulties with second taper junctions [1,11,16]. Fracture of a modular neck was reported in a 30-year-old man who after uncomplicated surgery fell and fractured the neck [1].…”

Section: Introductionmentioning

confidence: 99%

“…Clinical advantages of modular necks include the adjustment of leg length and offset via the head-neck taper, femoral anteversion via the neck-stem taper, easier revision when there is no clinical need to revise a well-fixed stem, and optimal restoration of soft tissue tension and patient biomechanics [7]. As a consequence of introducing a second taper junction, it has been reported, in single-patient case studies, multiple modular taper junctions present an additional site for failure [1,11,[23][24][25][26].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Proximal Component Modularity in THA—At What Cost?: An Implant Retrieval Study

Kop

Keogh

Swarts

2012

Clinical Orthopaedics &Amp; Related Research

130

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Background While modular femoral heads have been used in THA for decades, a recent innovation is a second neck-stem taper junction. Clinical advantages include intraoperative adjustment of leg length, femoral anteversion, and easier revision, all providing flexibility to the surgeon; however, there have been reports of catastrophic fracture, cold welding, and corrosion and fretting of the modular junction.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Proximal Component Modularity in THA—At What Cost?: An Implant Retrieval Study

Kop

Keogh

Swarts

2012

Clinical Orthopaedics &Amp; Related Research

130

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“…The taper junction of the THR, which is the focus of this study, is the interface between the internal taper of the modular femoral head and the trunnion of the femoral stem (see Figure 1) where the surgeon impacts the head onto the femoral stem during surgery. While the hip prosthesis is in service, the taper junction interface will be subjected to micromotion (Atwood et al, 2010;Hallab et al, 2004), which can lead to the release of metal debris due to fretting wear.…”

Section: Introductionmentioning

confidence: 99%

A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis

Ashkanfar

Langton

Joyce

2017

Journal of the Mechanical Behavior of Biomedical Materials

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A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis.http://researchonline.ljmu.ac.uk/5442/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Chromium femoral heads, which had been in service for 5.1 years in average, to validate the FE analyses. It was found that a large taper mismatch (e.g. 9.12´ ) results in a high wear rate (2.960mm 3 per million load cycles). Such wear rates can have a major negative effect on the clinical outcomes of these implants. It was also found that even a slight reduction in mismatch significantly reduced the magnitude of the wear rates (0.069mm 3 per million load cycles on average for 6´ taper mismatch). It is recommended that the cone angles of femoral head and femoral trunnion should be manufactured to produce a taper mismatch of less than 6´ at the taper junction.

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“…Complications of this modular junction include fretting [6-8, 12, 16, 23], crevice corrosion [6-8, 12, 13, 16, 23], and fracture of the trunnion [2,4,13,15,19,28]. The most common reason for revision of a unipolar endoprosthesis is stem loosening [1,10,27] or acetabular erosion from the large femoral head articulating on the host acetabular cartilage and not from complications of the trunnion [10,17,24,26,27].…”

Section: Introductionmentioning

confidence: 99%

Severe Metal-induced Osteolysis Many Years After Unipolar Hip Endoprosthesis

Mann

Tanzer

Tänzer

2013

Clinical Orthopaedics &Amp; Related Research

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Background Modularity of the femoral head-neck junction provides increased intraoperative flexibility to the surgeon. Complications of this modularity include damage to the trunnion, with subsequent bone and/or soft tissue loss from adverse reactions to metal debris. Case Description We describe two cases of severe metalinduced osteolysis and soft tissue damage requiring revision 10 and 13 years following implantation of a unipolar endoprosthesis. Damage to the trunnion resulted in severe acetabular and trochanteric osteolysis and soft tissue loss requiring complex revision surgery. Literature Review Several reports have shown the trunnion, the head-neck interface, and the neck-stem couple as the causes of this early failure secondary to metal ion release from mechanical fretting corrosion or from crevice corrosion at these modular interfaces. These reports have been in association with a total hip prosthesis rather than a unipolar endoprosthesis. Revision of a unipolar endoprosthesis is most commonly attributable to stem loosening or acetabular erosion from the large femoral head articulating on the host acetabular cartilage and not owing to failure of the trunnion. Purposes and Clinical Relevance Trunnion damage resulting in a severe reaction to metal debris with acetabular osteolysis, erosion of the greater trochanter, and loss of the abductor mechanism can occur years after implantation of a cementless unipolar endoprosthesis. This raises questions regarding long-term safety of the modular interface of a contemporary cementless stem and a large-diameter unipolar head. We recommend long-term followup of patients with a unipolar endoprosthesis as early recognition and treatment are required to avoid a potentially complex revision.

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Corrosion-Induced Fracture of a Double-Modular Hip Prosthesis

Cited by 139 publications

References 6 publications

Proximal Component Modularity in THA—At What Cost?: An Implant Retrieval Study

Proximal Component Modularity in THA—At What Cost?: An Implant Retrieval Study

A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis

Severe Metal-induced Osteolysis Many Years After Unipolar Hip Endoprosthesis

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