Failure of the Modular Neck in a Total Hip Arthroplasty

Dangles, Chris J.; Altstetter, C. J.

doi:10.1016/j.arth.2009.07.015

Cited by 92 publications

(74 citation statements)

References 8 publications

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“…The other method of failure in our study was bimodular neck fracture in approximately 5.6% of the PROFEMUR 1 Z stems (six of 107) and 0.6% of PROFEMUR 1 E stems (one of 170). There are several case reports regarding bimodular neck fracture of PROFEMUR 1 femoral stems [7,21,26]. Our data also suggest that long neck lengths, greater offset, and larger head diameters may potentiate failure of bimodular neck junctions.…”

Section: Discussionsupporting

confidence: 59%

“…However, failures of these components have been reported [2,7,15,27,28,30,31]; thus long-term survivorship of and complications associated with bimodular femoral neck components must be assessed to determine if the benefits outweigh the risks of failure. In our retrospective study, we evaluated a series of bimodular femoral neck implants used for primary THA to determine survivorship, main causes of failure, and the risk factors associated with them.…”

Section: Discussionmentioning

confidence: 99%

“…Because of a substantial rate of loosening by subsidence with the bimodular PROFEMUR 1 E, in 2006 the bimodular PROFEMUR 1 Z stem was chosen for use. Because of reports of fracture of the bimodular neck, use of PROFEMUR 1 stems that accommodated the bimodular neck was abandoned [5,7,13,16,28,32,33]. Bearing surface…”

Section: Methodsmentioning

confidence: 99%

“…Failures of bimodular necks have been reported, including bimodular neck fracture and corrosion with pseudotumor and periprosthetic loosening [2,7,15,27,28,30,31]. Mechanical analyses have suggested that corrosion-assisted fatigue is an important mechanism of failure, and design choices in metallurgy, offset, caput-column diaphysis angle, and mechanical stresses of physical activity are factors contributing to corrosion [7,11,16,33].…”

Section: Introductionmentioning

confidence: 99%

“…Mechanical analyses have suggested that corrosion-assisted fatigue is an important mechanism of failure, and design choices in metallurgy, offset, caput-column diaphysis angle, and mechanical stresses of physical activity are factors contributing to corrosion [7,11,16,33]. As with any new technology, the risk-benefit analysis must show that the advantages of modularity outweigh the risks.…”

Section: Introductionmentioning

confidence: 99%

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High Risk of Failure With Bimodular Femoral Components in THA

Pour

Borden

Murayama

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background The bimodular femoral neck implant (modularity in the neck section and prosthetic head) offers several implant advantages to the surgeon performing THAs, however, there have been reports of failure of bimodular femoral implants involving neck fractures or adverse tissue reaction to metal debris. We aimed to assess the results of the bimodular implants used in the THAs we performed. Questions/purposes We asked: (1) What is the survivorship of the PROFEMUR 1 bimodular femoral neck stems? (2) What are the modes of failure of this bimodular femoral neck implant? (3) What are the major risk factors for the major modes of failure of this device?Methods Between 2003 and 2009, we used one family of bimodular femoral neck stems for all primary THAs (PRO-FEMUR 1 Z and PROFEMUR 1 E). During this period, 277 THAs (in 242 patients) were performed with these implants. One hundred seventy were done with the bimodular PROFE-MUR 1 E (all are accounted for here), and when that implant was suspected of having a high risk of failure, the bimodular PROFEMUR 1 Z was used instead. One hundred seven THAs were performed using this implant (all are accounted for in this study). All bearing combinations, including metal-on-metal, metal-on-polyethylene, and ceramic-on-ceramic, are included here. Data for the cohort included patient demographics, BMI, implant dimensions, type of articular surface, length of followup, and C-reactive protein serum level. We assessed survivorship of the two stems using Kaplan-Meier curves and determined the frequency of the different modes of stem failure. For each of the major modes of failure, we performed binary logistic regression to identify associated risk factors. Results Survivorship of the stems, using aseptic revision as the endpoint, was 85% for the patients with the PROFE-MUR 1 E stems with a mean followup of 50 months (range, 1-125 months) and 85% for the PROFEMUR 1 Z with a mean followup of 50 months (range, 1-125 months)(95% CI, 74-87 months). The most common modes of failure were loosening (9% for the PROFEMUR 1 E), neck fracture (6% for the PROFEMUR 1 Z and 0.6% for the PROFEMUR 1 E), metallosis (1%), and periprosthetic fracture (1%). Only the bimodular PROFEMUR 1 E was associated with femoral stem loosening (odds ratio [OR] =1.1; 95% CI, 1.04-1.140; p = 0.032). Larger head (OR = 3.2; 95% CI, 0.7-14; p = 0.096), BMI (OR = 1.19; 95% CI, 1-1.4; p = 0.038) and total offset (OR = 1.83; 95% CI, 1.13-2.9; p = 0.039) were associated with neck fracture.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

High Risk of Failure With Bimodular Femoral Components in THA

Pour

Borden

Murayama

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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In vitro assessment of strength, fatigue durability, and disassembly of Ti6Al4V and CoCrMo necks in modular total hip replacements

et al. 2011

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Modularity in total hip replacement offers advantages with regard to biomechanical adjustments and leg lengths. Recently, modular femoral necks were introduced as an added advantage to head modularity permitting further adjustments in femoral version as well as offset and ease of revision. Currently, most necks are made of Ti6Al4V for which cases of in vivo fractures and inseparable neck-stem junctions have been reported. Therefore, we investigated CoCrMo head-Ti6Al4V stem hip replacements with necks made of CoCrMo as an alternative to Ti6Al4V. We compared the two materials with respect to (1) compressive load bearing capacity; (2) fatigue durability; and (3) component distraction. We performed in vitro fatigue-pull-off, microscopy, fatigue durability and compression investigations. The CoCrMo neck showed a load bearing capacity of 18 kN, 38% higher than 13 kN for the Ti6Al4V neck. A fatigue load of 11.2 kN for 1 million cycle failure was achieved with CoCrMo translating into nearly 1000 times longer fatigue life compared to Ti6Al4V necks. The neck-stem distraction force showed large statistical variation and was similar for both neck materials. Overall, the results suggest a superiority of CoCrMo over Ti6Al4V as neck material with regard to mechanical behavior. However, the corrosion behavior was not appropriately assessed and necessitates additional investigations.

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Effects of hip implant modular neck material and assembly method on fatigue life and distraction force

et al. 2016

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Hip implant neck fractures and adverse tissue reactions associated with fretting-corrosion damage at modular interfaces are a major source of concern. Therefore, there is an urgent clinical need to develop accurate in vitro test procedures to better understand, predict and prevent in vivo implant failures. This study aimed to simulate in vivo fatigue fracture and distraction of modular necks in an in vitro setting, and to assess the effects of neck material (Ti6Al4V vs. CoCrMo) and assembly method (hand vs. impact) on the fatigue life and distraction of the necks. Fatigue tests were performed on the cementless PROFEMUR® Total Hip Modular Neck System under two different loads and number of cycles: 2.3 kN for 5 million cycles, and 7.0 kN for 1.3 million cycles. The developed in vitro simulation setup successfully reproduced in vivo modular neck fracture mode and location. Neck failure occurred at the neck-stem taper and the fracture ran from the distal lateral neck surface to the proximal medial entry point of the neck into the stem. None of the necks failed under the 2.3 kN load. However, all hand-assembled Ti6Al4V necks failed under the 7.0 kN load. In contrast, none of the hand-assembled CoCrMo necks and impact-assembled necks (Ti6Al4V or CoCrMo) failed under this higher load. In conclusion, Ti6Al4V necks were more susceptible to fatigue failure than CoCrMo necks. In addition, impact assembly substantially improved the fatigue life of Ti6Al4V necks and also led to overall higher distraction forces for both neck materials. Overall, this study shows that the material and assembly method can affect the fatigue strength of modular necks. Finally, improper implant assembly during surgery may result in diminished modular neck survivability and increased failure rates. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2023-2030, 2017.

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Failure of the Modular Neck in a Total Hip Arthroplasty

Cited by 92 publications

References 8 publications

High Risk of Failure With Bimodular Femoral Components in THA

High Risk of Failure With Bimodular Femoral Components in THA

In vitro assessment of strength, fatigue durability, and disassembly of Ti6Al4V and CoCrMo necks in modular total hip replacements

Effects of hip implant modular neck material and assembly method on fatigue life and distraction force

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