Abstract

The modularity in total hip arthroplasty (THA) has reduced the inventory of the prosthetic system, allowing length and off-set adjustment of the limb, simplifying revision surgery through the replacement of the head only, whenever it is possible. Side effects of modularity, such as fretting and corrosion of the head-neck junction, are well known in revision surgery.

In this cases report we will describe a THA failure after 11 years on the head-neck junction of Accolade I femoral stem, chromium-cobalt (CoCr) femoral head and taper V40 (Stryker 1 Corporation, USA), and a THA failure after 4 years on the head-neck junction of SYMAX 7 (Ti-Al-V) femoral stem with cono-morse V40 (Stryker Orthopaedics) and large 50-4mm metal modular head (Co Cr Mo, Finsbury Orthopaedics), secondary to corrosion and subsequent disassembly of head-neck junction.

We will analyze the literature which highlights the need for greater awareness of the surgeon on the choice of the system implant about the modularity of the femoral neck-prosthetic head, evaluating the materials and geometry of the prosthetic components and overload and alignment of the implant that may be precondition for this complication with, occasionally, catastrophic results.

Keywords: Cono-Morse; Taper; Fretting; Corrosion; Disassembly

References

1. Bozic KJ., et al. “The epidemiology of revision total hip arthroplasty in the United States”. Journal of Bone and Joint Surgery American 91 (2009): 128-133.
2. Cooper HJ., et al. “Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty”. Journal of Bone and Joint Surgery Amer 94 (2012): 1655-1661.
3. Lee EW and Kim HT. “Early fatigue failures of cemented, forged, cobalt-chromium femoral stems at the neck-shoulder junction”. The Journal of Arthroplasty 16 (2001): 236-238.
4. Srinivasan A., et al. “Modularity of the femoral component in total hip arthroplasty”. Journal of the American Academy of Orthopaedic Surgeons 4 (2012): 214-222.
5. Dyrkacz RMR., et al. “The influence of head size on corrosion and fretting behaviour at the head-neck interface of artificial hip joints”. The Journal of Arthroplasty 6 (2013): 1036-1040.
6. Goldberg JR., et al. “A multicenter retrieval study of the taperBioMed Research International 7interfaces of modular hip prostheses”. Clinical Orthopaedics and Related Research 401 (2002): 149-161.
7. Higgs GB., et al. “Is increasedmodularity associated with increased fretting and corrosiondamage in Metal-on-Metal Total Hip Arthroplasty devices? Aretrieval study”. The Journal of Arthroplasty8 (2013): 2-6.
8. Higgs GB., et al. “Method of characterizing fretting and corrosion at the various taperconnections of retrieved modular components from metalon-metal total hip arthroplasty”. in Metal-on-Metal Total HipReplacement Devices, S. M. Kurtz, A. S. Greenwald, W. M.Mihalko, and J. Lemons, Editions., STP 1560, American Society for Testing and Materials, Conshohocken, Pa, USA (2013).
9. Langton DJ., et al. “Taper junction failure in large-diametermetal-on-metalbearings”. Bone and Joint Research 4 (2012): 56-63.
10. Nassif NA., et al. “Taper design affects failure of large-head metal-on-metal total hip replacements”. Clinical Orthopaedics and Related Research 2 (2014): 564-571.
11. Kurtz SM., et al. “Do ceramicfemoral heads reduce taper fretting corrosion in hip arthroplasty?A retrieval study”. Clinical Orthopaedics and Related Research 10 (2013): 3270-3282.
12. Brown SA., et al. “Frettingcorrosion accelerates crevice corrosion of modular hip tapers”. The Journal of Applied Biomaterials 1 (1995): 19-26.
13. Oxford Dictionaries (2014).
14. Hernigou P., et al. “One hundred and fifty years of history of the Morse taper: from Stephen A. Morse in 1864 to complications related tomodularity in hip arthroplasty”. International Orthopaedics 10 (2013): 2081-2088.
15. Hoeppner DW and Chandrasekaran V. “Fretting in orthopaedic implants: a review”. Wear 173 (1994): 189-197.
16. Brummitt IK., et al. “Effect of counterface material on the characteristics of retrieved uncemented cobalt-chromium and titanium alloy total hip replacements”. Proceedings of the Institution of Mechanical Engineers, Part H3 (1996): 191-195.
17. Australian Orthopaedic Association National Joint ReplacementRegistry, “Hip and knee arthroplasty” Annual Report (2013).
18. Moga I., et al. “Variables influ- encing tribo-corrosion of modular junctions in metal-on- polyethylene THR?” In Proceedings of the American Academy of Orthopedic Surgeons Annual Meeting, Paper 614 (2020): 2.
19. Norman TL., et al. “Taper-Trunnion Interface Stress Varies Significantly With Head Size and Activity”. Arthroplasty1 (2019): 157-162.
20. Sivakumar B., et al. “Fretting corrosion behaviour of Ti-6Al-4V alloy in artificial saliva containing varying concentrations of fluoride ions”. Wear 270 (2011): 317-324.
21. Virtanen S., et al. “Special modes of corrosion under ph.ysiological and simulated physiological conditions”. Acta Biomaterialia3 (2008): 468-476.
22. Hexter A., et al. “Mechanism of corrosion in large diameter head metal-on metal total hip arthroplasty: a retrieval analysis of 161 components”. Bone and Joint Journal-British Volume12 (2013): 4-9.
23. Rowan FA., et al. “The onset of fretting at the head-stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions”. Journal of Orthopaedic Research 6 (2018): 1630-1636.
24. Barrack RL., et al. “Stem design and dislocation after revision total hip arthroplasty: clinical results and computer modeling”. The Journal of Arthroplasty 1 (2001): 8-12.
25. Padgett DE., et al. “Influence of total hip design on dislocation: a computer model and clinical analysis”. Clinical Orthopaedics and Related Research 447 (2006): 48-52.
26. Rodriguez JA and Rathod PA. “Large diameter heads: is bigger always better?” The Journal of Bone and Joint Surgery British 94 (2012): 52-54.
27. Berry DJ., et al. “Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty”. Journal of Bone and Joint Surgery American11 (2005): 2456-2463.
28. Parekh J., et al. “Effect of angular mismatch tolerance on trunnion micro-motion in metal-on- metal THA designs”. Bone Joint Journal - British Volume34 (2013): 261-265.
29. Panagiotidou A., et al. “Enhanced wear and corrosion in modular tapers in total hip replacement is associated with the contact area and surface topography”. The Journal of Orthopaedic Research 31 (2013): 2032-2039.
30. Duisabeau L., et al. “Environmental effect on fretting of metallic materials for orthopaedic implants”. Wear 256 (2004): 805-816.
31. Kop AM., et al. “Proximal component modularity in THA-at what cost? An implant retrieval study”. Clinical Orthopaedics and Related Research 470 (2012): 1885-1894.
32. Hannouche D., et al. “Fractures of ceramic bearings: history and present status”. Clinical Orthopaedics and Related Research 417 (2003): 19-26.
33. Wylde CW., et al. “Catastrophic failure of the Accolade I hip arthroplasty stem: a retrieval analysis study”. HIP International 30 (2020): 481-487.
34. Morlock MM., et al. “Head Taper Corrosion Causing Head Bottoming Out and Consecutive Gross Stem Taper Failure in Total Hip Arthroplasty”. The Journal of Arthroplasty11 (2018): 3581-3590.
35. Spanyer J., et al. “Catastrophic Femoral Neck Failure after THA with the Accolade I Stem in Three Patients”. Clinical Orthopaedics and Related Research 474 (2016): 1333-1338.
36. Urban RM., et al. “Local histological and systemic effects ofmetalcorrosion products”. In Proceedings of the Hip Society Meeting,Chicago, Ill, USA (2013).
37. Lee SH., et al. “Human monocyte/macrophage response tocobalt-chromium corrosion products and titanium particles in patients with total joint replacements”. Journal of Orthopaedic Research 1 (1997): 40-49.
38. Trindade MCD., et al. “In vitro reaction to orthopaedic biomaterials by macrophages and lymphocytes isolated from patients undergoing revision surgery”. Biomaterials 22 (2001): 253-259.
39. Garbuz DS., et al. “The John Charnley award: metal-on-metal hip resur- facing versus large-diameter head metal-on-metal total hip arthroplasty: a randomized clinical trial”. Clinical Orthopaedics and Related Research 468 (2010): 318-
40. Engh CA., et al. “The surgical options and clinical evidence for treatment of wear or corrosion occurring with THA or TKA”. Clinical Orthopaedics and Related Research 472 (2014): 3674-3686.
41. Hussenbocus S., et al. “Head-Neck Taper Corrosion in Hip Arthroplasty”. BioMed Research Internationa Volume (2015): 9.
42. Rowan FE., et al. “The onset of fretting at the head-stem connection in hip arthroplasty is affected by head material and trunnion design under simulated corrosion conditions”. Journal of Orthopaedic Research6 (2018): 1630-1636.
43. Mroczkowski ML., et al. “Effect of impact assembly on the fret- ting corrosion of modular hip tapers”. Journal of Orthopaedic Research 24 (2006): 271-279.
44. Vail TP. “Complications: metal-on-metal articulations-design and technique related factors,” in Proceedings of the Hip Society Meeting, Chicago, Ill, USA (2013).
45. Rehmer A., et al. “Influence of assembly procedure and material combination on the strength of the taper connection at the head-neck junction of modular hip endoprostheses”. Clinical Biomechanics 27 (2012): 77-83.
46. Milosev L., et al. “Extensive metallosis and necrosis in failed prostheses with cemented titanium-alloy stems and ceramic heads”. Journal Bone Joint Surg British 82 (2000): 352-357.
47. Meneghini RM., et al. “Evaluation and treatment of painful total hip arthroplasties with modular metal taper junctions”. Orthopedics 35 (2012): 386-391.
48. Willmann G. “Ceramic femoral head retrieval data”. Clinical Orthopaedics and Related Research 379 (2000): 22-28.
49. Hannouche D., et al. “Is there a risk in placing a ceramic head on a pre- viously implanted trunion?” Clinical Orthopaedics and Related Research 468 (2010): 3322-3327.
50. Wight CM., et al. “Evidence based recommendations for reducing head-neck taper connection fretting corrosion in hip replacement prostheses”. HIP International6 (2017): 523-531.