Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches

Zajc, Jan; Moličnik, Andrej; Fokter, Samo Karl

doi:10.3390/ma14113078

Cited by 17 publications

(16 citation statements)

References 108 publications

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“…Repassivation in a crevice depletes the limited oxygen supply, thus decreasing the local pH and promoting further corrosion, resulting in pitting and the formation of sharp cracks 27 . In our series we did not observe such complication, however modular stem should be used with extreme caution especially in patients with an average weight over 100 kg 26 .…”

Section: Discussioncontrasting

confidence: 45%

“…From 2010 onwards, there is an increasing number of articles reporting dual modular stem design prosthesis failure, where sudden fractures of the modular neck at the neck-stem junction were reported as early as first years after implantation 24 – 26 . The reasons for a modular neck fracture of a Ti alloy are multifactorial 26 . Failure of modular titanium alloy neck adapters can be initiated by surface micromotions due to surface contamination or highly loaded implant components 26 .…”

Section: Discussionmentioning

confidence: 99%

“…The reasons for a modular neck fracture of a Ti alloy are multifactorial 26 . Failure of modular titanium alloy neck adapters can be initiated by surface micromotions due to surface contamination or highly loaded implant components 26 .…”

Section: Discussionmentioning

confidence: 99%

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Future of total hip arthroplasty with the Metha short stem in modern surgeries

Drobniewski

Synder

Krasińska

et al. 2021

Sci Rep

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The aim of the study was to analyse the results of uncemented total hip replacement, using the Metha (metaphyseal) stem. A total of 158 patients (70 females and 88 males) were qualified to the study and submitted to total hip arthroplasty (183 procedures altogether), using the Metha stem. The mean age of the patients on the day of surgery was 51.7 years (the range from 17 to 69 years). The mean follow up period was 9.2 years (the range from 5 to 13.5 years). Preoperative assessments gave poor scores, according to the Merle d’Aubigne and Postel classification, modified by Charnley. The average improvement after surgery, according to the used scale, was 6.9 points. A very good outcome was recorded in 154 cases (84.2%), a good outcome was achieved in 20 cases (10.9%) and a poor outcome was confirmed in 9 cases, while no satisfactory case was observed. Poor outcomes were associated with implant loosening. Extraskeletal ossification was noted in 10 cases (5.5%). According to the Kaplan–Meier estimator, the 10-year survival was 93.2% and 97.3% for the whole implant and the stem alone, respectively. 1. Our follow-up period of more than 9 years on the average, indicates that Metha stems produce excellent clinical and functional results in operated young patients with advanced degenerative changes of the hip joint. 2. Assuming a proper qualification for the procedure, the absence of complications and a correct surgical technique, which is slightly more difficult, when compared to standard stem implantation, the risk of aseptic loosening is fairly negligible.

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Section: Discussioncontrasting

confidence: 45%

Section: Discussionmentioning

confidence: 99%

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Future of total hip arthroplasty with the Metha short stem in modern surgeries

Drobniewski

Synder

Krasińska

et al. 2021

Sci Rep

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show abstract

“…However, corrosion and wear at the neck-stem junction led to unforeseen complications, such as implant fractures and increased revision rates, typically around 7 years postoperatively. 26,27 The most common patient report is insidious onset of groin, thigh, or buttock pain after a certain length of pain-free postoperative period. Workup in such cases involves obtaining serum markers, metal ion levels, and advanced imaging such as an MRI scan.…”

Section: Mechanically Assisted Crevice Corrosionmentioning

confidence: 99%

Trunnions and Modularity in Total Hip Arthroplasty: A Historical Review With Current Clinical Implications

Vajapey

Shah

2023

J Am Acad Orthop Surg

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Trunnion in total hip arthroplasty refers to the interface between the neck of a femoral stem and the femoral head. Clinical complications arising from damage to this junction, whether it be due to mechanical wear, corrosion, or a combination, are referred to as mechanically assisted crevice corrosion (MACC), also commonly known as trunnionosis. With the use of modular hip prostheses, which help customize offset and leg length to an individual patient's anatomy, the incidence of MACC and revision due to MACC has increased in recent years. Although the cause of MACC is multifactorial, with patient factors and technique factors contributing to this condition, taper design and geometry, metallurgical properties of implants, and size mismatch of the bearing couple are some of the implant factors that have also been implicated in this clinical phenomenon. Understanding the history of taper design and geometry, the track record of older implants, and the rationale behind the development of current prostheses can help surgeons choose the right implants for their patients and accurately assess the pros and cons of new implants being introduced to the market each year. Charnley 1 became the father of the modern total hip arthroplasty (THA) when he introduced his low-friction design in 1961. He used acrylic cement to fix metal to live bone, polyethylene as a bearing surface, and monoblock femoral implant with a small head for low frictional torque. Introduction of modularity allowed the separation of Charnley monoblock femoral implant into the femoral stem and femoral head. This allowed fine-tuning of the femoral offset and leg length independent of the femoral stem size, thus facilitating customization of the implant to the individual's anatomy. 2 However, modularity comes with its own risks and disadvantages, and understanding these can help the orthopaedic surgeon decrease the risk of complications after THA.

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“…However, in a recent systematic review by Zajc et al , the authors confirmed the shortcomings of using the modular-neck titanium alloy, with no added clinical benefits due to possible worse durability as compared to monolithic stems. However, they suggested that some designs are still being marketed and used worldwide, and the choice to use Ti-6Al-4 V dual modular stem designs during primary THA should be on a selective basis [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Updates in biomaterials of bearing surfaces in total hip arthroplasty

Khalifa

Bakr

2021

Arthroplasty

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Total hip arthroplasty (THA) is one of the most successful surgical procedures. It entails replacement of the damaged or diseased joint surface with artificial materials. Various materials had been developed and used to achieve optimal outcomes, including longer survivorship and minimal complications. The primary materials used in the manufacture of THA implants are polymers, metal alloys, and ceramics. The failures of THA mainly result from aseptic loosening due to the production of wear particles and the development of periprosthetic joint injection. A lot of advancement and introduction of new biomaterials in THA implants’ armamentarium are designed to avoid the common failure mechanisms and improve the longevity of the implants. In this review, we discussed various aspects of commonly used biomaterials in THA implants, to provide some updated information.

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Dual Modular Titanium Alloy Femoral Stem Failure Mechanisms and Suggested Clinical Approaches

Cited by 17 publications

References 108 publications

Future of total hip arthroplasty with the Metha short stem in modern surgeries

Future of total hip arthroplasty with the Metha short stem in modern surgeries

Trunnions and Modularity in Total Hip Arthroplasty: A Historical Review With Current Clinical Implications

Updates in biomaterials of bearing surfaces in total hip arthroplasty

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