Crevice Corrosion of Cemented Titanium Alloy Stems in Total Hip Replacements

Willert, H.‐G.; Brobäck, L G; Buchhorn, Gottfried; Jensen, Paw; Köster, Georg; Lang, Imke; Ochsner, P. E.; Schenk, R.

doi:10.1097/00003086-199612000-00006

Cited by 140 publications

(113 citation statements)

References 40 publications

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“…Spindle-shaped cortical thickening and scalloping osteolysis secondary to corrosion and abrasion of cemented titanium femoral stems have recently been reported at postoperative intervals (cortical thickening at twenty-four months and osteolysis at thirty-five months) similar to those in our study 16 . It is likely that a similar mechanism of accelerated corrosion occurred at the taper junctions in the three-piece nails in our patients.…”

Section: Resultssupporting

confidence: 90%

“…The second of these products was quite similar in histologic and gross appearance, as well as in elemental composition, to the chromium orthophosphate hydrate-rich corrosion product reported in association with both similar-metal and mixed-metal modular femoral total hip-replacement components 7,[12][13][14] . There is evidence that these chromium orthophosphate hydrate-rich corrosion products may cause osteolysis not only by increasing polyethylene wear through a three-body mechanism but also through a cellular response from macrophages leading to bone resorption through a separate mechanism 12,15,16 . Metal debris has been shown to stimulate osteoclast production leading to bone resorption 17 .…”

Section: Resultsmentioning

confidence: 99%

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Focal Osteolysis at the Junctions of a Modular Stainless-Steel Femoral Intramedullary Nail

Jones¹,

Marsh²,

Nepola³

et al. 2001

The Journal of Bone and Joint Surgery-American Volume

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Background: During routine follow-up of patients treated with a three-piece stainless-steel modular femoral nail, osteolysis and periosteal reaction around the modular junctions of some of the nails were noted on radiographs. The purpose of this study was to evaluate the prevalence, etiology, and clinical relevance of these radiographic findings. Methods: Forty-four femoral fractures or nonunions in forty-two patients were treated with a modular stainlesssteel femoral intramedullary nail. Seventeen nails were excluded, leaving twenty-seven intramedullary nails in twenty-seven patients for this study. All patients had had a femoral diaphyseal fracture; nineteen had had an acute fracture and eight, a nonunion. These twenty-seven patients returned for radiographs, a physical examination, assessment of functional outcomes, assessment of thigh pain with a visual analog scale, determination of serum chromium levels, and nail removal if desired. A control group of sixteen patients treated with a one-piece stainless-steel femoral intramedullary nail was evaluated with use of the same outcome measures and was compared with the group treated with the modular femoral nail with regard to prevalence of thigh pain and serum chromium levels. Twelve modular femoral nails were removed according to the study protocol. The modular nail junctions were analyzed for corrosion products, and histopathologic analysis of tissue specimens from the femoral canal was performed. Results: The twenty-seven patients were seen at a mean of twenty-one months after fracture fixation; twenty-six of the twenty-seven fractures healed. Twenty-three femora had at least one of three types of abnormalitiesosteoly-sis, periosteal reaction, or cortical thickeninglocalized to one or both modular junctions. Eighteen patients had severe reactions, defined as osteolysis of ≥2 mm, cortical thickening of ≥5 mm, and/or a periosteal reaction (group 1). Nine patients had mild or no reactions (group 2). Serum chromium levels in group 1 (mean, 1.27 ng/ mL; range, 0.34 to 3.12 ng/mL) were twice as high as those in group 2 (mean, 0.53 ng/mL; range, 0.12 to 1.26 ng/mL). However, this difference did not reach significance with the numbers available. The differences in serum chromium levels between group 1 and the control group with a one-piece nail (mean, 0.26 ng/mL; range, 0.015 to 1.25 ng/mL) (p < 0.01) and a control group without an implant (mean, 0.05 ng/mL; range, 0.015 to 0.25 ng/ mL) (p < 0.01) were significant. The level of thigh pain recorded on the visual analog scale was also significantly different between group 1 and the control group with a one-piece implant (p = 0.03). Retrieved modular nails had signs of fretting corrosion as well as stainless-steel corrosion products adherent to the junction where the osteolysis occurred. Histologic and spectrographic analysis revealed two types of corrosion products that were consistent with stainless-steel within the peri-implant tissue and were associated with a foreign-body granulomatous response. Conclusions: The ...

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Section: Resultssupporting

confidence: 90%

Section: Resultsmentioning

confidence: 99%

Focal Osteolysis at the Junctions of a Modular Stainless-Steel Femoral Intramedullary Nail

Jones¹,

Marsh²,

Nepola³

et al. 2001

The Journal of Bone and Joint Surgery-American Volume

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“…It is thought that the compression of debris within the interfaces, along with further oxidation/redox of any metallic debris, results in the formation of thick Cr2O3 rich films within the interface. Mechanical mixing of the fretting-corrosion products with organic material will also occur, similar to the mechanisms described by Willert et al (Willert et al, 1996) who described fresh synovial fluid to freely enter the interface as the stem-cement surfaces became separated, resulting the films to become a mixture of Cr2O3 and organic material.…”

Section: Influence Of Fretting Corrosion On Local Environmentsupporting

confidence: 52%

Characterisation of the surface topography, tomography and chemistry of fretting corrosion product found on retrieved polished femoral stems

Bryant

Ward

Farrar³

et al. 2014

Journal of the Mechanical Behavior of Biomedical Materials

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eprints@whiterose.ac.uk https://eprints.whiterose.ac.uk/ Reuse Unless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. CHARACTERISATION OF THE SURFACE TOPOGRAPHY, TOMOGRAPHY HIGHLIGHTS: The tomography of retrieved femoral stems was characterised. Directionality and plastic deformation of the metallic surfaces was seen. Thick deposited layers were seen to occur within the stem-cement interfaces. Films of Cr2O3 bound with organic material play an important role in the degradation.

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“…A retrieval analysis of 28 cemented ti-alloy modular Muller stems (Sulzer, Baar, Switzerland) demonstrated corrosion phenomena at the surface of the stem [39]. The design parameters of the stem were considered crucial in the development of this corrosion.…”

Section: Resultsmentioning

confidence: 99%

Mid-term results and migration behaviour of a ti-alloy cemented stem

Meek

Michos

Grigoris

et al. 2002

International Orthopaedics

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Between 1991 and 1994, 147 patients (154 hips) underwent a primary cemented total hip replacement using the Ultima ti-alloy, collarless, double-tapered stem and a UHMWPE cup. The average age at operation was 66.4 years. Ninety-one patients (97 hips) were available for review with an average follow-up of 76 months. The Harris hip score had improved from pre-operative average of 43.1 (12.5-65.0) to the latest score of 88.9 (67.5-100). There were 11 revisions in total, eight of which were for aseptic stem loosening. The results of Kaplan-Meier survival analysis, based on stem revision for aseptic loosening as an end-point, was 92% at 8 years. Early stem migration analysis at 2 years was possible in 114 cases using digitised radiographs analysed by the EBRA method. Sixty-three stems had not migrated and 35 migrated less than 2 mm with only one of these ending in failure. Sixteen stems showed early migration of more than 2 mm and five of these failed. Early stem migration is predictive of stem failure. Osteolytic lesions occurred in 12 femurs and four of these stems failed.Résumé Entre 1991 et 1994, 147 malades (154 hanches) ont subi une arthroplastie primaire cimentée qui utilise une tige à section décroissante Ultima sans collerette en alliage de Titane et une cupule de UHMWPE. L'âge moyen à l'opération était 66.4 ans. Quatre-vingtonze malades (97 hanches) étaient disponibles pour la révision avec une moyenne de suivi de 76 mois. Le score de Harris s'est amélioré de la moyenne préopératoire de 43.1 (12.5 à 65.0) au score le plus tardif de 88.9 (67.5 à 100). Il y avait 11 révisions, huit pour descellement aseptique de la tige. La survie selon KaplanMeyer, basée sur la révision de la tige pour descellement aseptique était 92% à huit années. L'analyse du descellement précoce de la tige à deux années était possible dans 114 cas utilisant des radiographies digitalisées analysées par la méthode EBRA. Soixante-trois tiges n'avaient pas migré et trente-cinq tiges avaient migré de moins de 2 mm avec seul cas évoluant vers un échec. Seize tiges ont montré une migration de plus de 2 mm avec finalement cinq échecs. La migration préco-ce de la tige est prédictif du descellement. Les lésions ostéolytique se sont produites sur 12 fémurs conduisant à quatre échecs par descellement fémoral.

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Crevice Corrosion of Cemented Titanium Alloy Stems in Total Hip Replacements

Cited by 140 publications

References 40 publications

Focal Osteolysis at the Junctions of a Modular Stainless-Steel Femoral Intramedullary Nail

Focal Osteolysis at the Junctions of a Modular Stainless-Steel Femoral Intramedullary Nail

Characterisation of the surface topography, tomography and chemistry of fretting corrosion product found on retrieved polished femoral stems

Mid-term results and migration behaviour of a ti-alloy cemented stem

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