Pseudotumor in a Well-Fixed Metal-on-Polyethylene Uncemented Hip Arthroplasty

Mao, Xinzhan; Tay, Guan; Godbolt, David; Crawford, Ross

doi:10.1016/j.arth.2011.07.015

Cited by 88 publications

(76 citation statements)

References 30 publications

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“…There have also been reports of adverse reactions to metal debris due to metallic wear debris produced from the taper junction for MoP THR (Cooper et al, 2012;Lindgren et al, 2011;Mao et al, 2012). The taper junction of the THR, which is the focus of this study, is the interface between the internal taper of the modular femoral head and the trunnion of the femoral stem (see Figure 1) where the surgeon impacts the head onto the femoral stem during surgery.…”

Section: Introductionmentioning

confidence: 99%

A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis

Ashkanfar

Langton

Joyce

2017

Journal of the Mechanical Behavior of Biomedical Materials

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A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis.http://researchonline.ljmu.ac.uk/5442/ Article LJMU has developed LJMU Research Online for users to access the research output of the University more effectively. Copyright © and Moral Rights for the papers on this site are retained by the individual authors and/or other copyright owners. Users may download and/or print one copy of any article(s) in LJMU Research Online to facilitate their private study or for non-commercial research. You may not engage in further distribution of the material or use it for any profit-making activities or any commercial gain.The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting galley proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Chromium femoral heads, which had been in service for 5.1 years in average, to validate the FE analyses. It was found that a large taper mismatch (e.g. 9.12´ ) results in a high wear rate (2.960mm 3 per million load cycles). Such wear rates can have a major negative effect on the clinical outcomes of these implants. It was also found that even a slight reduction in mismatch significantly reduced the magnitude of the wear rates (0.069mm 3 per million load cycles on average for 6´ taper mismatch). It is recommended that the cone angles of femoral head and femoral trunnion should be manufactured to produce a taper mismatch of less than 6´ at the taper junction.

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Section: Introductionmentioning

confidence: 99%

A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis

Ashkanfar

Langton

Joyce

2017

Journal of the Mechanical Behavior of Biomedical Materials

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“…These reports have focused on metallosis presumably as a result of corrosion at the head and neck junction or the neck-stem modular junction in modular stems. All of these patients were symptomatic on presentation [2,6,9,10,13,17]. Williams et al [20] reported abnormalities through ultrasound in three of 24 asymptomatic patients with MoP bearings.…”

Section: Discussionmentioning

confidence: 99%

“…These aggressive periarticular granulomatous masses were usually diagnosed on pelvic CT or ultrasound rather than MRI in an era of poor-quality polyethylene. Recently MARS MRIs have been used to document ALTRs after MoP total hips that have no discernible reasons for symptoms [2,6,9,10,13,17]. These reports have focused on metallosis presumably as a result of corrosion at the head and neck junction or the neck-stem modular junction in modular stems.…”

Section: Discussionmentioning

confidence: 99%

Metal Artifact Reduction Sequence MRI Abnormalities Occur in Metal-on-polyethylene Hips

Fehring

Odum

2015

Clinical Orthopaedics &Amp; Related Research

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Background To determine the importance of MRI abnormalities in metal-on-metal (MoM) bearings, it is important to understand the baseline features of this diagnostic tool in conventional metal-on-polyethylene (MoP) bearings.Questions/purposes What are the frequency, size, and types of MRI-documented adverse local tissue reactions in asymptomatic patients with MoP bearings? Methods We recruited 50 patients 5 years after a MoP total hip arthroplasty from a pool of patients in our joint registry who had a Harris hip score of [ 90. To be included, patients had to be without pain and have adequate radiographs. Our data set included 50 asymptomatic patients with MoP bearings who underwent a metal artifact reduction sequence MRI. Results MRI abnormalities were seen in 14 of 50 (28%) asymptomatic patients who were studied. Thirteen of the 14 abnormalities were cystic thin-walled lesions with a mean of 18 cm 3 (range, 1-79 cm 3 ). Conclusions MRI abnormalities were noted in nearly one-third of asymptomatic patients with MoP bearings. Decisions concerning revision of MoM bearings should not be based on isolated MRI findings because MRI abnormalities are commonly seen regardless of bearing type. A number of factors should determine the need for intervention including pain, mechanical symptoms, abductor weakness, component type, component position, and ion levels as well as MRI findings.

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“…Two of the final articles were removed because they addressed corrosion secondary to stem loosening and a knee modular revision component. This left nine articles focused on corrosion in femoral hip components [9,10,23,29,32,37,42,46,47].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…There were nine studies identified addressing the surgical treatment of implant failures secondary to taper corrosion (Table 5) [9,10,23,29,32,37,42,46,47]. Eight articles were case report studies and one was Level IV.…”

Section: Treatment Of Corrosionmentioning

confidence: 99%

The Surgical Options and Clinical Evidence for Treatment of Wear or Corrosion Occurring With THA or TKA

Engh

Padgett

2014

Clin Orthop Relat Res

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Background Wear and corrosion occurring in patients with hip and knee arthroplasty are common causes of failure leading to revision surgery. A variety of surgical approaches to these problems have been described, with varying efficacy. Polyethylene wear, metal-on-metal (MoM) hip bearing wear, and problems associated with modular taper corrosion are the areas of greatest clinical impact; results of revisions for these problems are likely to dictate a large portion of revision resources for the foreseeable future, and so they call for specific study. Questions/purposes We identified the most frequently reported procedures to treat hip polyethylene wear, knee polyethylene wear, MoM wear after THA, and modular taper corrosion and determined the timing and reasons these failed. Methods We performed systematic reviews of the published literature on the four topics using MEDLINE 1 and Embase in October 2013; searches were supplemented by hand searches of bibliographies. Prespecified criteria resulted in the identification of 38 relevant articles, of which 33 were either case reports or Level IV evidence. Followup was generally at short term and ranged from 0.2 to 8 years. Results The most frequently reported procedures for treating clinically important wear were a partial or complete revision. When treating polyethylene wear, the more frequently reported reasons for hip and knee rerevisions were loosening, continued wear, and instability. Soft tissue reactions were more common and occasionally extensive in patients with MoM or modular taper corrosion. Patients with soft tissue reactions had more complications and higher rerevision rates. Conclusions Studies with longer followup and higher levels of evidence are needed to direct the treatment of wear and corrosion. When soft tissue damage secondary to MoM wear or taper corrosion is present, the results of treatment can be poor. There is an urgent need to better understand these two mechanisms of failure.

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Pseudotumor in a Well-Fixed Metal-on-Polyethylene Uncemented Hip Arthroplasty

Cited by 88 publications

References 30 publications

A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis

A large taper mismatch is one of the key factors behind high wear rates and failure at the taper junction of total hip replacements: A finite element wear analysis

Metal Artifact Reduction Sequence MRI Abnormalities Occur in Metal-on-polyethylene Hips

The Surgical Options and Clinical Evidence for Treatment of Wear or Corrosion Occurring With THA or TKA

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