The influence of stem taper re-use upon the failure load of ceramic heads

Gührs, Julian; Krull, Annika; Witt, F.; Morlock, Michael M.

doi:10.1016/j.medengphy.2015.03.010

Cited by 20 publications

(11 citation statements)

References 33 publications

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“…However, the available data remain inconclusive as to their relevance, and their actual impact remains unclear even to date. Other factors excluded from the analytical model, but under the direct influence of the surgeon, are the impaction technique [6] and the avoidance of mismatch by combining heads and stems with different taper designs (i.e., from different manufacturers) [25,67,68,84].…”

Section: Discussionmentioning

confidence: 99%

“…However, all these parameters are associated with the chosen design of the prosthesis and may not be modifiable intraoperatively. Taper incongruences caused by mixing heads and tapers from different manufacturers might affect the strength of the taper connection and must be avoided, given the variability of the effect associated with cobalt-chromium (CoCr) heads, because taper incongruences may critically reduce the fracture load of ceramic heads [67,68], and because of certification issues. Gross trunnion failures are reportedly above average for tapers made of beta titanium alloy (titanium-molybdenum-zirconium-iron (TMZF)) [34].…”

Section: Technical Aspects Of Taper Connections In Hip Arthroplastymentioning

confidence: 99%

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What the Surgeon Can Do to Reduce the Risk of Trunnionosis in Hip Arthroplasty: Recommendations from the Literature

Rieker

Wahl

2020

Materials

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Trunnionosis, defined as wear and corrosion at the head-neck taper connection, is a cause of failure in hip arthroplasty. Trunnionosis is linked to a synergistic combination of factors related to the prosthesis, the patient, and the surgeon. This review presents analytical models that allow for the quantification of the impact of these factors, with the aim of providing practical recommendations to help surgeons minimize the occurrence of this failure mode. A tighter fit reduces micromotion and, consequently, fretting of the taper connection. The paramount parameters controlling the fixation force are the coefficient of friction and the impaction force. The influence of the head diameter, as well as of the diameter and angle of the taper, is comparatively small, but varus alignment of the taper and heads with longer necks are unfavourable under physiologic loads. The trunnion should be rinsed, cleaned, and dried carefully, while avoiding any contamination of the bore-the female counterpart within the head-prior to assembly. Biological debris, and even residual water, might critically reduce the fixation of the taper connection between the head and the neck. The impaction force applied to the components should correspond to at least two strong blows with a 500 g hammer, striking the head with an ad hoc impactor aligned with the axis of the taper. These strong blows should correspond to a minimum impaction force of 4000 N.

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Section: Discussionmentioning

confidence: 99%

Section: Technical Aspects Of Taper Connections In Hip Arthroplastymentioning

confidence: 99%

What the Surgeon Can Do to Reduce the Risk of Trunnionosis in Hip Arthroplasty: Recommendations from the Literature

Rieker

Wahl

2020

Materials

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“…Indeed, recent findings of corrosion of metallic heads have propagated the use of ceramics as an alternative bearing material. While complications with ceramics in primary THA are uncommon, revising to a monolithic ceramic head requires the use of an additional titanium sleeved junction which may corrode, opens up the possibility for phase transformation while in vivo [3,10,14], and may cause further susceptibility to fracture or third body wear [13,19,21,22,36]. This fracture risk is eliminated when OxZr heads are used [34].…”

Section: Discussionmentioning

confidence: 99%

Characterization of Femoral Head Taper Corrosion Features Using a 22-Year Retrieval Database

Cartner

Aldinger

et al. 2017

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: Modularity in total hip arthroplasty has been used for decades with great success, but new findings regarding corrosion artifacts have caused a resurgence in tapered junction research. Mechanically assisted crevice corrosion (MACC) is thought to be the mechanism by which corrosive attack occurs. Myriad multi-factorial variables are known to influence the susceptibility of a modular taper junction to MACC. Some of these variables are design and manufacture related and others can be controlled by the surgeon. Questions/Purposes: This study was performed to assess a 22-year retrieval database to determine if correlations exist between severity of corrosion artifacts and head size, time in vivo, head offset, or head material. Secondarily, the agreement of visual and semi-quantitative scoring methods was assessed using the retrieved components. Methods: A total of 210 femoral head tapers were scored and heads receiving high scores were measured to quantify material loss due to MACC. Results: Increased head size and increased time in vivo did not correlate to higher corrosion scores. Contrarily, there were differences in corrosion scores based on femoral head offset and material. Deviations away from a neutral offset (where neutral is defined as the alignment of femoral head center and stem taper gage point) resulted in higher scores. Cobalt-chromium-molybdenum heads were associated with higher corrosion scores and higher material loss as compared to oxidized zirconium heads. Conclusion: Reducing the moment arm at the head-neck junction and choosing a more inert material appears to provide greater resistance to corrosion.

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“…Caution is advised in using ceramic heads with titanium sleeves in the primary situation. Introducing such an additional interface is necessary in revision surgeries, if a new ceramic head is placed on a preused male taper [20]. It is not indicated in primary surgeries.…”

Section: Taper Design Implant Configuration and Loadingmentioning

confidence: 99%

Corrosion of the Head-Stem Taper Junction—Are We on the Verge of an Epidemic?

Morlock

Bünte

Gührs

et al. 2017

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: The modular head taper junction has contributed to the success of total hip arthroplasty (THA) greatly. Taper corrosion and wear problems reported for large and extralarge metal-on-metal bearings as well as for bi-modular THA stems have cast doubt on the benefit of the taper interface. Presently, corrosion problems are being reported for nearly all kinds of artificial hip joints incorporating metal heads, questioning taper connections in general. Questions/purposes: This study aimed to review the mechanical and electrochemical relationships that may lead to taper corrosion, which have been reported more commonly in recent literature, and to also review the contribution of patient characteristics and surgical techniques involved in taper assembly that may contribute to the problem. Methods: The search criteria B(corrosion) AND (hip arthroplasty) AND (taper OR trunnion)^and B(hip arthroplasty) AND ((pseudotumor) OR (pseudo-tumor))^in PubMed and the JAAOS were used for the literature search. In addition, the arthroplasty registers were considered. Results: Most studies acknowledge the multifactorial nature of the problem but concentrate their analysis on taper and implant design aspects, since this is the only factor that can be easily quantified. The sometimes conflicting results in the literature could be due to the fact that the other two decisive factors are not sufficiently considered: the loading situation in the patient and the assembly situation by the surgeon. All three factors together determine the fate of a taper junction in THA. There is no single reason as a main cause for taper corrosion. The combined Boutcome^of these three factors has to be in a Bsafe range^to achieve a successful longterm taper fixation. Conclusion: No, this is not the beginning of an epidemic. It is rather the consequence of disregarding known mechanical and electrochemical relationships, which in combination have recently caused a more frequent occurrence-and mainly reporting-of corrosion issues.

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The influence of stem taper re-use upon the failure load of ceramic heads

Cited by 20 publications

References 33 publications

What the Surgeon Can Do to Reduce the Risk of Trunnionosis in Hip Arthroplasty: Recommendations from the Literature

What the Surgeon Can Do to Reduce the Risk of Trunnionosis in Hip Arthroplasty: Recommendations from the Literature

Characterization of Femoral Head Taper Corrosion Features Using a 22-Year Retrieval Database

Corrosion of the Head-Stem Taper Junction—Are We on the Verge of an Epidemic?

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