Is Increased Modularity Associated With Increased Fretting and Corrosion Damage in Metal-On-Metal Total Hip Arthroplasty Devices?

Higgs, Genymphas B.; Hanzlik, J; MacDonald, Daniel W.; Gilbert, Jeremy L.; Rimnac, Clare M.; Kurtz, Steven M.

doi:10.1016/j.arth.2013.05.040

Cited by 161 publications

(119 citation statements)

References 18 publications

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“…Collier et al [8], in a cohort of 411 modular prostheses, reported a positive correlation between corrosion and length of implantation, although the bearing combinations (eg, MoM and MoP) were not reported. Similar results were reported for MoM cohorts [14,20]. Interestingly, Goldberg et al [19] found that although corrosion of the head and neck increased with time, head fretting actually decreased, an effect attributed to etching or buildup of corrosion debris.…”

Section: Discussionsupporting

confidence: 70%

“…Studies with MoM bearings concluded that larger heads are associated with greater fretting and corrosion severity [3,20]. In contrast, recent studies associating head size and corrosion in MoP THAs are conflicting.…”

Section: Discussionmentioning

confidence: 93%

“…Femoral head size has been associated with the severity of fretting and corrosion at the junction with ultralarge ([ 36 mm) MoM THAs, which were used for the advantages of greater ROM and decreased dislocation risk [1,3,14,20,26,29]. Larger heads produce increased rotational and bending moments at the junction and can increase micromotion between the junction contact surfaces [20]. This phenomenon was particularly evident with MoM THAs, where simulator data indicated that lack of lubrication between bearing surfaces caused increased friction moments at the head-neck junction [2].…”

Section: Clinical Orthopaedics and Related Researchmentioning

confidence: 99%

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Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties

Triantafyllopoulos

Elpers

Burket

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Fretting and corrosion at head-neck junctions of total hip arthroplasties (THAs) have been associated with adverse local tissue reactions in patients with both metal-onpolyethylene (MoP) and metal-on-metal (MoM) prostheses. Femoral head size contributes to the severity of fretting and corrosion in large-diameter MoM THAs, but its impact on such damage in MoP THAs remains unknown. Questions/purposes (1) Is femoral head size associated with increased fretting or corrosion at the head-neck junction in MoP total hips? (2) Is duration of implantation associated with increased fretting or corrosion? Methods The severity of fretting/corrosion on surfaces of head tapers and stem trunnions was visually examined in 154 MoP THAs retrieved as part of 3282 revision surgeries performed at our institution between January 1, 2007, and December 31, 2013. Fretting and corrosion damage were subjectively graded by two independent observers on a 1 to 4 scale, and their relations to head size, alloy combinations, taper/trunnion design, length of implantation (LOI), and location were investigated. Differences in scores never exceeded one grade, and this occurred in only 17% of examined implants. With the available implants, the study provided 88% power to detect differences of 0.5 in fretting or corrosion scores in these analyses. Results Fretting and corrosion of the tapers and the trunnions were not affected by head size (p = 0.247, p = 0.471, p = 0.837, and p = 0.868, respectively), although taper/trunnion design affected taper fretting (p = 0.005) and corrosion (p = 0.0031) and trunnion fretting (p = 0.0028). Head taper fretting (observed in 73% of heads) increased with LOI, but head taper corrosion (noted in 93% of heads) was not affected. Trunnion fretting (observed in 86% of stems) was more severe in mixed-alloy combinations and with increased LOI and was more severe proximally. Trunnion corrosion (noted in 72% of stems) was also location-dependent with greater corrosion distally. Conclusions Fretting and corrosion are regular occurrences in MoP THAs, but neither damage type was related to femoral head size. Conversely, taper design, LOI, and alloy combination affected the severity of both fretting and corrosion.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 93%

Section: Clinical Orthopaedics and Related Researchmentioning

confidence: 99%

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Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties

Triantafyllopoulos

Elpers

Burket

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…In dual modular stems, material coupling and the taper design are also crucial for the micromotion magnitude at the stem-neck junction with titanium neck adapters having significantly higher interface micromotions than those with CoCr adapters [29]. The additional stem-neck junction in dual modular stems has been associated with increased damage at the head-stem junction [22].…”

Section: What Clinical Problems Have Been Reported In Patients With Mmentioning

confidence: 99%

“…Larger head sizes increase torsional forces at the trunnion [9], and this may be a contributing factor in the increased failure rates seen metalon-metal (MoM) THAs [17,22], which have a high revision rate of 19% after 12 years [2]. Increasing head offset and increasing varus neck shaft angle have been considered with head size, leading to an increased effective horizontal lever arm [32].…”

Section: What Clinical Problems Have Been Reported In Patients With Mmentioning

confidence: 99%

What is the Trouble With Trunnions?

Esposito¹,

Wright²,

Goodman³

et al. 2014

Clin Orthop Relat Res

112

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Atomic Scale Origin of Metal Ion Release from Hip Implant Taper Junctions

et al. 2020

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Millions worldwide suffer from arthritis of the hips, and total hip replacement is a clinically successful treatment for end‐stage arthritis patients. Typical hip implants incorporate a cobalt alloy (Co–Cr–Mo) femoral head fixed on a titanium alloy (Ti‐6Al‐4V) femoral stem via a Morse taper junction. However, fretting and corrosion at this junction can cause release of wear particles and metal ions from the metallic implant, leading to local and systemic toxicity in patients. This study is a multiscale structural‐chemical investigation, ranging from the micrometer down to the atomic scale, of the underlying mechanisms leading to metal ion release from such taper junctions. Correlative transmission electron microscopy and atom probe tomography reveals microstructural and compositional alterations in the subsurface of the titanium alloy subjected to in vitro gross‐slip fretting against the cobalt alloy. Even though the cobalt alloy is comparatively more wear‐resistant, changes in the titanium alloy promote tribocorrosion and subsequent degradation of the cobalt alloy. These observations regarding the concurrent occurrence of electrochemical and tribological phenomena are vital to further improve the design and performance of taper junctions in similar environments.

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Is Increased Modularity Associated With Increased Fretting and Corrosion Damage in Metal-On-Metal Total Hip Arthroplasty Devices?

Cited by 161 publications

References 18 publications

Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties

Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties

What is the Trouble With Trunnions?

Atomic Scale Origin of Metal Ion Release from Hip Implant Taper Junctions

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