In Vivo Corrosion of Modular Dual-Mobility Implants: A Retrieval Study

Kolz, Joshua M.; Wyles, Cody C.; Citters, Douglas W. Van; Chapman, Ryan M.; Trousdale, Robert T.; Berry, Daniel J.

doi:10.1016/j.arth.2020.05.075

Cited by 30 publications

(37 citation statements)

References 20 publications

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“… 31 Subsequent in vitro modelling in the same study suggested that liner malseating can lead to lower fretting onset loads. Taken together, these results corroborate findings by Kolz et al 30 describing three different patterns of wear, and suggest that debris generation in MDM constructs is likely a combination of intrinsic (component design) and extrinsic (surgical) factors. Surgeons, if choosing to use an MDM construct, should therefore take extra care to ensure that screw heads are completely recessed within the holes of the acetabular shell, and the metal liner is properly seated.…”

Section: Discussionsupporting

confidence: 90%

“…Kolz et al found significant material loss on the metal liner in all 12 of their cases, but those revised for ARMD ( n = 3) did not show significantly higher fretting corrosion scores. 30 The two other studies found no significant increase in fretting corrosion of MDM compared to MoM or ADM constructs ( n = 36), 28 , 29 with no cases revised due to ARMD. Whilst this is somewhat reassuring, there was one reported case of macroscopic damage on the backside of the inner metal liner seemingly from acetabular screw heads ( Fig.…”

Section: Discussionmentioning

confidence: 89%

“… 28 , 29 The third, most recent, implant retrieval study reported clinically significant material loss in all implants of varying severity. 30 …”

Section: Resultsmentioning

confidence: 99%

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Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis

et al. 2021

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Modular dual-mobility (MDM) constructs can be used to reduce dislocation rates after total hip replacement (THR). However, there are concerns about adverse reaction to metal debris (ARMD) as a result of fretting corrosion between the metal liner and shell. This systematic review reports outcomes following THR using MDM components. It was registered with PROSPERO and conducted in line with Cochrane and PRISMA recommendations. Sixteen articles were included overall, with meta-analysis performed on relevant subsets using a random intercept logistic regression model. Estimated median incidence of ARMD requiring revision surgery within study follow-up period was 0.3% (95% CI 0.1 – 1.8%, from 11 cohort studies containing 1312 cases). Serum metal ion levels were mildly raised in 7.9% of cases, and significantly raised in 1.8%, but there was no correlation with worse clinical hip function scores within studies. Dislocation rate was 0.8%. Revision rate was 3.3%. There are mixed reports of wear on the backside of the metal liner from the acetabular shell and screw heads. Both implant design and component malseating are implicated, but currently it is unclear to what extent each factor is responsible. Studies were poor quality with high risk of confounding, especially from trunnion corrosion. We have made recommendations for further work. In the meantime, surgeons should be aware of the potential risk of ARMD when considering using an MDM prosthesis, and, if selecting one, must ensure proper seating of the liner and screws intraoperatively. Cite this article: EFORT Open Rev 2021;6:343-353. DOI: 10.1302/2058-5241.6.200146

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 89%

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Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis

et al. 2021

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“…This, in turn, poses the risk of taper corrosion and adverse tissue reaction. A retrieval study on the corrosion of the Trident acetabular system with modular dual-mobility implants demonstrated that 17% of liners had severe corrosion and 42% of the liners had moderate corrosion [33]. Although the aforementioned couple involved a titanium acetabular shell and a cobalt-chromium dual-mobility liner, rather than the titanium acetabular shell with a titaniumbacked ceramic liner in the current study, titanium-titanium taper corrosion resulting in adverse local tissue reaction had been reported in the modular femoral stem [34].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome on the Mal-Seating of Ceramic-on-Ceramic Articulation in Total Hip Arthroplasty

Chung¹,

Cheung²,

Fan

et al. 2021

The Journal of Arthroplasty

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Background: Total hip arthroplasty with ceramic-on-ceramic articulation aims to decrease wear, osteolysis, and aseptic loosening. A metal-backed ceramic liner was developed to reduce the risk of liner fracture. However, a significant number of cases of mal-seating of the metal-backed ceramic liner were observed in the 2000s, and there were concerns about their outcome. This review aims to investigate the long-term performance of the mal-seated ceramic liner. Methods: From July 2003 to March 2007, 35 ceramic-on-ceramic total hip arthroplasties were performed with the Trident acetabular system. Clinical assessment, radiological analysis, and outcome assessment were performed. The prevalence of liner mal-seating and its long-term outcomes were investigated. Results: There was liner mal-seating in 8 hips (22.9%). One liner was exchanged in the early postoperative period. No revision surgery was required for the remaining 7 hips at a mean follow-up of 14 years. All patients were free of hip pain with a mean Harris Hip Score of 94.7 at the most recent followup. No adverse event was observed. Conclusion:The long-term outcomes of the mal-seated liner were favorable. However, surgeons should exercise meticulous surgical technique to achieve a properly aligned liner within the acetabular shell to minimize this potentially correctable error.

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“…However, the metal-on-metal interface between CoCr liner and titanium cup is at risk of fretting corrosion and remains a concern. (175)(176)(177) Metal ions can further lead to advance local tissue reaction (ALRT) and implant loosening. (178) The rst study regarding metal ions was conducted by Matsen Ko et al, which revealed 21% of the patient had elevated serum chromium levels.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Modes for Implant Failure in the Modern Dual Mobility Implant. A Systematic Review and Meta-analysis 

Pai

Chou

et al. 2020

Preprint

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Background The aims of this meta-analysis were to: (1) validate the outcome of modern dual mobility (DM) designs in patients who had undergone primary and revision total hip arthroplasty (THA) procedures and (2) to identify factors that affect the outcome.Methods We searched for studies that assessed the outcome of modern DM-THA in primary and revision procedures that have been conducted between January, 2000 to August, 2020 on PubMed, MEDLINE, Cochrane Reviews and Embase. The pooled incidence of common failure modes and functional scores were evaluated in patients who have received: (1) primary THA, (2) revision THA for all causes or (3) for recurrent dislocation. A meta-regression analysis was performed for each parameter to determine the association with the outcome.Results A total of 120 studies (N= 30016 DM-THAs) were included for analysis. The mean follow-up duration was 47.3 months. The overall implant failure rate was 4.2% (primary: 2.3%, revision for all causes: 5.5%, recurrent dislocation: 6.0%). The most common failure modes were aseptic loosening (primary: 0.9%, revision for all causes: 2.2%, recurrent dislocation: 2.4%), septic loosening (primary:0.8%, revision for all causes: 2.3%, recurrent dislocation: 2.5%), extra-articular dislocation (primary:0.6%, revision for all causes:1.3%, recurrent dislocation:2.5%), intra-prosthetic dislocation (primary:0.8%, revision for all causes:1.0%, recurrent dislocation:1.6%) and periprosthetic fracture (primary:0.9%, revision for all causes:0.9%, recurrent dislocation:1.3%). The multi-regression analysis identified younger age (β=-0.04, 95% CI -0.07 – -0.02) and female patients (β=3.34, 95% CI 0.91–5.78) were correlated with higher implant failure rate. Age, gender, posterolateral approach and body mass index (BMI) were not risk factors for extra-articular or intra-prosthetic dislocation in this cohort. The overall Harris hip score and Merle d’Aubigné score were 84.87 and 16.36, respectively.Conclusion Modern dual-mobility designs provide satisfactory mid-term implant survival and clinical performance. Younger age and female patients might impact the outcome after DM-THA.

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In Vivo Corrosion of Modular Dual-Mobility Implants: A Retrieval Study

Cited by 30 publications

References 20 publications

Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis

Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis

Long-Term Outcome on the Mal-Seating of Ceramic-on-Ceramic Articulation in Total Hip Arthroplasty

Risk Factors and Modes for Implant Failure in the Modern Dual Mobility Implant. A Systematic Review and Meta-analysis

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In Vivo Corrosion of Modular Dual-Mobility Implants: A Retrieval Study

Cited by 30 publications

References 20 publications

Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis

Adverse reaction to metal debris due to fretting corrosion between the acetabular components of modular dual-mobility constructs in total hip replacement: a systematic review and meta-analysis

Long-Term Outcome on the Mal-Seating of Ceramic-on-Ceramic Articulation in Total Hip Arthroplasty

Risk Factors and Modes for Implant Failure in the Modern Dual Mobility Implant. A Systematic Review and Meta-analysis&nbsp;

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Risk Factors and Modes for Implant Failure in the Modern Dual Mobility Implant. A Systematic Review and Meta-analysis