In Vivo Damage of the Head-Neck Junction in Hard-on-Hard Total Hip Replacements: Effect of Femoral Head Size, Metal Combination, and 12/14 Taper Design

Baleani, Massimiliano; Erani, Paolo; Bordini, Barbara; Zuccheri, Federica; Mąkosa, Mateusz Kordian; Pasquale, Dalila De; Beraudi, Alina; Stea, Susanna

doi:10.3390/ma10070733

Cited by 11 publications

(7 citation statements)

References 78 publications

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“…Interestingly, minimal cobalt was found in the corrosion particles on the implant surfaces (Mathiesen et al, 1991; Urban et al, 1997). These observations were later confirmed by other researchers (Huber et al, 2009; Chana et al, 2012; Baleani et al, 2017). The Cr-rich fretting corrosion products with low or depleted Co indicated that Co was released in the form of soluble species.…”

Section: Mechanisms Of Implant Degradationsupporting

confidence: 73%

Mechanisms of Adverse Local Tissue Reactions to Hip Implants

Eltit

Wang

2019

Front. Bioeng. Biotechnol.

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Adverse Local Tissue Reactions (ALTRs) are one of the main causes of hip implant failures. Although the metal release from the implants is considered as a main etiology, the mechanisms, and the roles of the released products are topics of ongoing research. The alloys used in the hip implants are considered biocompatible and show negligible corrosion in the body environment under static conditions. However, modularity and its associated mechanically assisted corrosion have been shown to release metal species into the body fluids. ALTRs associated with metal release have been observed in hip implants with metal-on-metal articulation initially, and later with metal-on-polyethylene articulation, the most commonly used design in current hip replacement. The etiological factors in ALTRs have been the topics of many studies. One commonly accepted theory is that the interactions between the metal species and body proteins and cells generate a delayed type IV hypersensitivity reaction leading to ALTRs. However, lymphocyte reactions are not always observed in ALTRS, and the molecular mechanisms have not been clearly demonstrated. A more accepted mechanism is that cell damage generated by metal ions may trigger the secretion of cytokines leading to the inflammatory reactions observed in ALTRs. In this inflammatory environment, some patients would develop hypersensitivity that is associated with poor outcomes. Concerns over ALTRS have brought significant impact to both the clinical selection and development of hip implants. This review is focused on the mechanisms of ALTRs, specifically, the metal release process and the roles of the metal species released in the etiology and pathogenesis of the disease. Hopefully, our presentation and discussion of this biological process from a material perspective could improve our current understanding on the ALTRs and provide useful guidance in developing preventive solutions.

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Section: Mechanisms Of Implant Degradationsupporting

confidence: 73%

Mechanisms of Adverse Local Tissue Reactions to Hip Implants

Eltit

Wang

2019

Front. Bioeng. Biotechnol.

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“…Evidence supporting the proposed mode of failure can be found in the literature. Analysis of retrieved ceramic heads and male tapers has revealed that some minor damage, mainly localized damage to the ridges of the taper machining grooves associated with light metal transfer to the bore surface, takes place in well-working bore–taper junctions [ 26 , 27 ]. However, suboptimal seating increases both contact pressure and micromotion amplitude at the bore–taper interface under physiological load [ 28 ], thus promoting fretting-corrosion damage of the taper [ 29 , 30 ] and crack nucleation at the ceramic surface [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture

et al. 2022

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Background Ceramic bearings are used in total hip arthroplasty due to their excellent wear behaviour and biocompatibility. The major concern related to their use is material brittleness, which significantly impacts on the risk of fracture of ceramic components. Fracture toughness improvement has contributed to the decrease in fracture rate, at least of the prosthetic head. However, the root cause behind these rare events is not fully understood. This study evaluated head fracture occurrence in a sizeable cohort of patients with fourth-generation ceramic-on-ceramic implants and described the circumstances reported by patients in the rare cases of head fracture. Methods The clinical survivorship of 29,495 hip prostheses, with fourth-generation ceramic bearings, was determined using data from a joint replacement registry. The average follow-up period was 5.2 years (range 0.1–15.6). Retrieval analysis was performed in one case for which the ceramic components were available. Results Clinical outcomes confirmed the extremely low fracture rate of fourth-generation ceramic heads: only two out of 29,495 heads fractured. The two fractures, both involving 36 mm heads, occurred without a concurrent or previous remarkable trauma. Considering the feature of the fractured head, a multi-stage crack growth mechanism has been hypothesized to occur following damage at the head–neck taper interface. Conclusions Surgeons must continue to pay attention to the assembly of the femoral head: achieving a proper head seating on a clean taper is a prerequisite to decrease the risk of occurrence of any damage process within head–neck junction, which may cause high stress concentration at the contact surface, promoting crack nucleation and propagation even in toughened ceramics.

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“…Due to material dimensions restrictions, in this case, a 12 mm diameter rod, it was not possible to obtain a cone with real dimensions of the most used geometries in total hip arthroplasty. [26][27][28][29][30] Therefore, the 6°Ca angle was chosen equal to the 12/14 type cone, in which the 12 mm dimension corresponds to the Dcd.…”

Section: Methodsmentioning

confidence: 99%

Comparative study of titanium alloys machinability used for medical applications

Festas

Carvalho

Horovistiz

et al. 2022

Proceedings of the Institution of Mechanical Engineers, Part E:

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CNC machining manufacturing is critical to the development of biomedical industries, especially orthopaedic implants. Understanding a material's machinability under different cutting conditions is essential for component design as well as for optimizing the machining process. Despite their widespread use in the biomedical industry, α + β-type titanium (Ti) alloys, such as Ti-6Al-4V and Ti-6Al-7Nb, are being replaced by β or near β-type Ti alloys like Ti-13Nb-13Zr Ti alloy due to issues associated with Vanadium and Aluminium toxicity and lower modulus of elasticity. By simulating the machining of a functional cone of the hip prosthesis femoral component, this work aims to investigate some aspects of the machinability of titanium alloys: Ti-6Al-4V, Ti-6Al-7Nb, and Ti-13Nb-alloy 13Zr. Cutting forces values were registered during the tests. Using correlative microscopy, machined surfaces were examined by measuring roughness and topographic examination. According to the results obtained, the new titanium alloy Ti-13Nb-13Zr alloy presents lower cutting forces and a worse surface finish for a lower feed rate. However, when the feed rate was increased to double the initial value, this alloy had the smallest increase in Ra, compared with the other alloys under test The effect of federate is highly significant in cutting forces and surface finish, with increases in cutting forces of 35%, 45% and 66% on cutting forces for Ti-13Nb-13Zr, Ti-6Al-4V and Ti-6Al-7Nb, respectively.

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In Vivo Damage of the Head-Neck Junction in Hard-on-Hard Total Hip Replacements: Effect of Femoral Head Size, Metal Combination, and 12/14 Taper Design

Cited by 11 publications

References 78 publications

Mechanisms of Adverse Local Tissue Reactions to Hip Implants

Mechanisms of Adverse Local Tissue Reactions to Hip Implants

A case-driven hypothesis for multi-stage crack growth mechanism in fourth-generation ceramic head fracture

Comparative study of titanium alloys machinability used for medical applications

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