Wear debris in metal-on-metal bearings and modular junctions

Knecht, Cory; Polakof, Landon S.; Behrens, Jonathan; Goodman, Stuart B.

doi:10.1007/s00132-023-04346-w

Cited by 3 publications

(5 citation statements)

References 31 publications

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“…139 Metal particles are approximately 10 times smaller and 500 times higher in quantity than polymeric wear particles. 140 Metal ions and particles cause a specific lymphocyte-mediated adverse local tissue reaction and osteolysis. It should be noted, however, that ions and particles (or bulk material) may induce different local tissue reactions.…”

Section: How Can We Modulate the Inflammatory And Foreign Body Respon...mentioning

confidence: 99%

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Friend or foe? Inflammation and the foreign body response to orthopedic biomaterials

Gibon,

Takakubo,

Zwingenberger

et al. 2023

J Biomedical Materials Res

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The use of biomaterials and implants for joint replacement, fracture fixation, spinal stabilization and other orthopedic indications has revolutionized patient care by reliably decreasing pain and improving function. These surgical procedures always invoke an acute inflammatory reaction initially, that in most cases, readily subsides. Occasionally, chronic inflammation around the implant develops and persists; this results in unremitting pain and compromises function. The etiology of chronic inflammation may be specific, such as with infection, or be unknown. The histological hallmarks of chronic inflammation include activated macrophages, fibroblasts, T cell subsets, and other cells of the innate immune system. The presence of cells of the adaptive immune system usually indicates allergic reactions to metallic haptens. A foreign body reaction is composed of activated macrophages, giant cells, fibroblasts, and other cells often distributed in a characteristic histological arrangement; this reaction is usually due to particulate debris and other byproducts from the biomaterials used in the implant. Both chronic inflammation and the foreign body response have adverse biological effects on the integration of the implant with the surrounding tissues. Strategies to mitigate chronic inflammation and the foreign body response will enhance the initial incorporation and longevity of the implant, and thereby, improve long‐term pain relief and overall function for the patient. The seminal research performed in the laboratory of Dr. James Anderson and co‐workers has provided an inspirational and driving force for our laboratory's work on the interactions and crosstalk among cells of the mesenchymal, immune, and vascular lineages, and orthopedic biomaterials. Dr. Anderson's delineation of the fundamental biologic processes and mechanisms underlying acute and chronic inflammation, the foreign body response, resolution, and eventual functional integration of implants in different organ systems has provided researchers with a strategic approach to the use of biomaterials to improve health in numerous clinical scenarios.

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Section: How Can We Modulate the Inflammatory And Foreign Body Respon...mentioning

confidence: 99%

“…Metal particles are approximately 10 times smaller and 500 times higher in quantity than polymeric wear particles 140 . Metal ions and particles cause a specific lymphocyte‐mediated adverse local tissue reaction and osteolysis.…”

Section: How Can We Modulate the Inflammatory And Foreign Body Respon...mentioning

confidence: 99%

Friend or foe? Inflammation and the foreign body response to orthopedic biomaterials

Gibon,

Takakubo,

Zwingenberger

et al. 2023

J Biomedical Materials Res

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show abstract

“…High concentrations of cobalt and chromium in the blood were also reported as a harmful effect of fretting corrosion [47]. This is in addition to other effects of corrosion such as metal ions and particles at modular taper junctions [48][49][50][51][52][53], which have been reported as a link to hypersensitivity, lymphatic reactivity, chromosomal damage, local tissue toxicity, malignant transformation, and impaired renal function [54,55]. As a result, more active patients may be prone to more severe corrosion at modular junctions.…”

Section: Demographics Meanmentioning

confidence: 99%

Fretting Wear and Corrosion-Related Risk Factors in Total Hip Replacement: A Literature Review on Implant Retrieval Studies and National Joint Replacement Registry Reports

Ghadirinejad,

Day,

Milimonfared

et al. 2023

Prosthesis

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Fretting corrosion is a known failure mechanism of total hip replacement (THR) that can lead to revision surgery. Implant retrieval studies have thoroughly documented the occurrence of fretting corrosion in THR implants and its correlation with implant- and patient-related factors. Although implant retrieval studies benefit both clinicians and implant manufacturers, the limitations of these types of studies need to be acknowledged. For example, while some factors are routinely investigated for a possible correlation with failure due to fretting corrosion, other factors are often assumed to have no effect. To improve on these limitations, this review investigates the most significant patient- and implant-related risk factors for fretting corrosion of THR implants for both published retrieval studies and joint replacement registries. The findings and limitations are discussed critically. It is concluded that retrieval studies add significant insight into implant failure mechanisms and should be used in conjunction with joint replacement registry reports. It is suggested that the development of reliable predictive models based on implant failure risk factors and decision-making support systems could lead to enhanced implant longevity.

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“…Over the years, the development of bearing materials has undergone significant advancements to address the challenges associated with wear and friction. In the past, metal‐on‐metal bearings were utilized, but their use has significantly decreased due to concerns over metallosis and adverse local tissue reactions, prompting a shift towards alternative bearing materials 2 . Then, metal‐on‐polyethylene (MoP) bearings were widely used and proven its good longevity; however, concerns regarding polyethylene wear and the release of metal debris causing metallosis emerged as possible drawbacks of this material 3 …”

Section: Introductionmentioning

confidence: 99%

“…In the past, metal-on-metal bearings were utilized, but their use has significantly decreased due to concerns over metallosis and adverse local tissue reactions, prompting a shift towards alternative bearing materials. 2 Then, metal-on-polyethylene (MoP) bearings were widely used and proven its good longevity; however, concerns regarding polyethylene wear and the release of metal debris causing metallosis emerged as possible drawbacks of this material. 3 Ceramic-on-ceramic (CoC) bearing THA has proven its lowest wear rate that leads to minimal osteolysis and longer implant survival.…”

Section: Introductionmentioning

confidence: 99%

Ceramic‐on‐Ceramic or Metal‐on‐Polyethylene: The Bearing of Choice after Ceramic Component Fracture in Total Hip Arthroplasty along with Concise Follow‐Up of the Previous Cohort

Kim,

Lee,

Lee

et al. 2023

Orthopaedic Surgery

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ObjectiveWe previously reported the questionable result of reoperation using metal‐on‐polyethylene (MoP) bearing after the fracture of the ceramic component. After the report, we abandoned the use of MoP; instead, we used ceramic‐on‐ceramic (CoC) bearing. This report aimed to present the outcome of reoperation to CoC bearing after ceramic component failures along with the longer‐term outcome of the previously reported cohort with an MoP bearing.ResultsThe mean follow‐up of the MoP cohort was extended from 4.3 years to 8.8 years. Metallosis had occurred in three of nine patients of the previous cohort, which all required re‐reoperations. Two hips from 11 patients with revision to CoC had re‐reoperations due to ceramic liner fracture and non‐union of the osteotomized fragment, respectively. No metallosis and wear occurred in the cohort revised with CoC articulation. Otherwise, there were no adverse changes in radiographs and no impairment in functions.MethodsWe conducted an extended prospective evaluation of a previous cohort consisting of six head fractures and three liner fractures. In this cohort, the patients underwent a bearing change to metal‐on‐polyethylene. Additionally, we retrospectively analyzed 11 cases of third‐generation ceramic bearing fractures, comprising nine head fractures and two liner fractures. These cases were subsequently treated with a bearing change to fourth‐generation CoC. We assessed clinical and radiological outcomes, including complication rates, in both groups.ConclusionWe recommend the latest CoC as the bearing of choice in reoperation after the fracture of ceramic components. In the case of an MoP bearing after the ceramic component fracture, the risk of metallosis seemed high in the early postoperative period.

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Wear debris in metal-on-metal bearings and modular junctions

Cited by 3 publications

References 31 publications

Friend or foe? Inflammation and the foreign body response to orthopedic biomaterials

Friend or foe? Inflammation and the foreign body response to orthopedic biomaterials

Fretting Wear and Corrosion-Related Risk Factors in Total Hip Replacement: A Literature Review on Implant Retrieval Studies and National Joint Replacement Registry Reports

Ceramic‐on‐Ceramic or Metal‐on‐Polyethylene: The Bearing of Choice after Ceramic Component Fracture in Total Hip Arthroplasty along with Concise Follow‐Up of the Previous Cohort

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