nach oben

Clinical Orthopaedics and Related Research®

Erschienen in:

01.12.2014 | Symposium: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements

What is the Trouble With Trunnions?

verfasst von: Christina I. Esposito, PhD, Timothy M. Wright, PhD, Stuart B. Goodman, MD, PhD, Daniel J. Berry, MD, The Clinical, Biological and Bioengineering Study Groups from the Carl T. Brighton Workshop

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 12/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

Recent studies have attributed adverse local tissue reactions (ALTRs) in patients with total hip arthroplasties (THAs) to tribocorrosion debris generated by modular femoral stems. The presentations of ALTR are diverse, as are the causes of it, and the biological responses can be important reasons for failure after THA.

Question/purposes

(1) What clinical problems have been reported in patients with modular stems since 1988? (2) What THA design features are associated with tribocorrosion in taper junctions? (3) What are the microscopic and tribological characteristics of the debris produced at the taper junctions? (4) What are the cellular and immunological traits of the biological response to taper tribocorrosion debris?

Methods

We conducted a systematic review using MEDLINE and EMBASE-cited articles to summarize failure modes associated with modular femoral stems. One hundred sixty-two of 1043 articles reported on the clinical performances or failure modes attributed to modular femoral stems. There were 10 laboratory studies, 26 case reports, 13 Level IV, 94 Level III, 18 Level II, and one Level I of Evidence papers. To address the remaining questions, we did a second review of 524 articles. One hundred twenty-seven articles met the eligibility criteria, including 81 articles on design features related to tribocorrosion, 15 articles on corrosion debris characteristics, and 31 articles on the biological response to tribocorrosion debris.

Results

Sixty-eight of 162 studies reported failure attributed to modular femoral stems for one of these four modularity-related failure modes: tribocorrosion-associated ALTR, dissociation of a taper junction, stem fracture, and mismatch of a femoral head taper attached to a stem with a different trunnion size. The remaining 94 studies found no clinical consequences related to the presence of a taper junction. THA component features associated with tribocorrosion included trunnion geometry and large-diameter femoral heads. Solid tribocorrosion debris is primarily chromium-orthophosphate material of variable size and may be more biologically reactive than wear debris.

Conclusions

There has been an increase in publications describing ALTR around modular hip prostheses in the last 3 years. Implant design changes, including larger femoral heads and smaller trunnions, have been implicated, but there may also be more recognition of the problem by the orthopaedic community. Analyzing retrieved implants to understand the history of taper-related problems, designing clinically relevant in vitro corrosion tests to test modular junctions, and identifying biomarkers to recognize patients at risk of ALTR should be the focus of ongoing research to help surgeons avoid and detect tribocorrosion-related problems in joint replacements.

Nur mit Berechtigung zugänglich

Al-Saffar N. Early clinical failure of total joint replacement in association with follicular proliferation of B-lymphocytes: a report of two cases. J Bone Joint Surg Am. 2002;84:2270–2273.PubMed

Anonymous. Australian Orthopaedic Association National Joint Replacement Registry. Annual Report. Adelaide, Australia: AOA; 2013.

Baxmann M, Jauch SY, Schilling C, Blomer W, Grupp TM, Morlock MM. The influence of contact conditions and micromotions on the fretting behavior of modular titanium alloy taper connections. Med Eng Phys. 2013;35:676–683; discussion 676.PubMedCrossRef

Berry DJ, Abdel MP, Callaghan JJ. What are the current clinical issues in wear and tribocorrosion? Clin Orthop Relat Res. 2014 Apr 8 [Epub ahead of print].

Bolland BJ, Culliford DJ, Langton DJ, Millington JPS, Arden NK, Latham JM. High failure rates with a large-diameter hybrid metal-on-metal total hip replacement. Clinical, radiological and retrieval analysis. J Bone Joint Surg Br. 2011;93:608–615.PubMedCrossRef

Braun E, Schmitt D, Nabet F, Legras B, Coudane H, Mole D. [Urinary concentration of cobalt and chromium in patients with a non-cemented total hip prosthesis] [in French]. Int Orthop. 1986;10:277–282.PubMedCrossRef

Brown SA, Flemming CA, Kawalec JS, Placko HE, Vassaux C, Merritt K, Payer JH, Kraay MJ. Fretting corrosion accelerates crevice corrosion of modular hip tapers. J Appl Biomater. 1995;6:19–26.PubMedCrossRef

Bryant M, Ward M, Farrar R, Freeman R, Brummitt K, Nolan J, Neville A. Characterisation of the surface topography, tomography and chemistry of fretting corrosion product found on retrieved polished femoral stems. J Mech Behav Biomed Mater. 2014;32:321–334.PubMedCrossRef

Burroughs BR, Muratoglu OK, Bragdon CR, Wannomae KK, Christensen S, Lozynsky AJ, Harris WH. In vitro comparison of frictional torque and torsional resistance of aged conventional gamma-in-nitrogen sterilized polyethylene versus aged highly crosslinked polyethylene articulating against head sizes larger than 32 mm. Acta Orthop. 2006;77:710–718.PubMedCrossRef

10.

Cales B, Stefani Y. Risks and advantages in standardization of bores and cones for heads in modular hip prostheses. J Biomed Mater Res. 1998;43:62–68.PubMedCrossRef

11.

Chana R, Esposito C, Campbell PA, Walter WK, Walter WL. Mixing and matching causing taper wear: corrosion associated with pseudotumour formation. J Bone Joint Surg. Br. 2012;94:281–286.PubMedCrossRef

12.

Collier JP, Surprenant VA, Jensen RE, Mayor MB, Surprenant HP. Corrosion between the components of modular femoral hip prostheses. J Bone Joint Surg Br. 1992;74:511–517.PubMed

13.

Cooper HJ, Della Valle CJ, Berger RA, Tetreault M, Paprosky WG, Sporer SM, Jacobs JJ. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am. 2012;94:1655–1661.PubMed

14.

De Smet K, De Haan R, Calistri A, Campbell PA, Ebramzadeh E, Pattyn C, Gill HS. Metal ion measurement as a diagnostic tool to identify problems with metal-on-metal hip resurfacing. J Bone Joint Surg Am. 2008;90(Suppl 4):202–208.PubMedCrossRef

15.

Donaldson FE, Coburn JC, Siegel KL. Total hip arthroplasty head-neck contact mechanics: a stochastic investigation of key parameters. J Biomech. 2014;47:1634–1641.PubMedCrossRef

16.

Dyrkacz RMR, Brandt J-M, Ojo OA, Turgeon TR, Wyss UP. The influence of head size on corrosion and fretting behaviour at the head-neck interface of artificial hip joints. J Arthroplasty. 2013;28:1036–1040.PubMedCrossRef

17.

Elkins JM, Callaghan JJ, Brown TD. Stability and trunnion wear potential in large-diameter metal-on-metal total hips: a finite element analysis. Clin Orthop Relat Res. 2014;472:529–542.PubMedCrossRef

18.

Goldberg JR, Gilbert JL, Jacobs JJ, Bauer TW, Paprosky W, Leurgans S. A multicenter retrieval study of the taper interfaces of modular hip prostheses. Clin Orthop Relat Res. 2002;401:149–161.PubMedCrossRef

19.

Grupp TM, Weik T, Bloemer W, Knaebel H-P. Modular titanium alloy neck adapter failures in hip replacement—failure mode analysis and influence of implant material. BMC Musculoskelet Disord. 2010;11:3.PubMedCentralPubMedCrossRef

20.

Hallab NJ, Messina C, Skipor A, Jacobs JJ. Differences in the fretting corrosion of metal-metal and ceramic-metal modular junctions of total hip replacements. J Orthop Res. 2004;22:250–259.PubMedCrossRef

21.

Hart AJ, Quinn PD, Sampson B, Sandison A, Atkinson KD, Skinner JA, Powell JJ, Mosselmans JFW. The chemical form of metallic debris in tissues surrounding metal-on-metal hips with unexplained failure. Acta Biomater. 2010;6:4439–4446.PubMedCrossRef

22.

Higgs GB, Hanzlik JA, MacDonald DW, Gilbert JL, Rimnac CM, Kurtz SM. Is increased modularity associated with increased fretting and corrosion damage in metal-on-metal total hip arthroplasty devices? A retrieval study. J Arthroplasty. 2013;28(Suppl):2–6.PubMedCentralPubMedCrossRef

23.

Hohman DW, Affonso J, Anders M. Ceramic-on-ceramic failure secondary to head-neck taper mismatch. Am J Orthop (Belle Mead, NJ). 2011;40:571–573.

24.

Huber M, Reinisch G, Trettenhahn G, Zweymuller K, Lintner F. Presence of corrosion products and hypersensitivity-associated reactions in periprosthetic tissue after aseptic loosening of total hip replacements with metal bearing surfaces. Acta Biomater. 2009;5:172–180.PubMedCrossRef

25.

Huot Carlson JC, Van Citters DW, Currier JH, Bryant AM, Mayor MB, Collier JP. Femoral stem fracture and in vivo corrosion of retrieved modular femoral hips. J Arthroplasty. 2012;27:1386–1396.e1.

26.

Jacobs JJ, Gilbert JL, Urban RM. Corrosion of metal orthopaedic implants. J Bone Joint Surg Am. 1998;80:268–282.PubMed

27.

Jacobs JJ, Skipor AK, Patterson LM, Hallab NJ, Paprosky WG, Black J, Galante JO. Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study. J Bone Joint Surg Am. 1998;80:1447–1458.PubMed

28.

Jacobs JJ, Urban RM, Gilbert JL, Skipor AK, Black J, Jasty M, Galante JO. Local and distant products from modularity. Clin Orthop Relat Res. 1995;319:94–105.PubMed

29.

Jauch SY, Huber G, Haschke H, Sellenschloh K, Morlock MM. Design parameters and the material coupling are decisive for the micromotion magnitude at the stem-neck interface of bi-modular hip implants. Med Eng Phys. 2014;36:300–307.PubMedCrossRef

30.

Khair MM, Nam D, DiCarlo E, Su E. Aseptic lymphocyte dominated vasculitis-associated lesion resulting from trunnion corrosion in a cobalt-chrome unipolar hemiarthroplasty. J Arthroplasty. 2013;28:196.e11–14.PubMed

31.

Kurtz SM, Kocagoz SB, Hanzlik JA, Underwood RJ, Gilbert JL, MacDonald DW, Lee G-C, Mont MA, Kraay MJ, Klein GR, Parvizi J, Rimnac CM. Do ceramic femoral heads reduce taper fretting corrosion in hip arthroplasty? A retrieval study. Clin Orthop Relat Res. 2013;471:3270–3282.PubMedCentralPubMedCrossRef

32.

Langton DJ, Sidaginamale R, Lord JK, Nargol AVF, Joyce TJ. Taper junction failure in large-diameter metal-on-metal bearings. Bone Joint Res. 2012;1:56–63.PubMedCentralPubMedCrossRef

33.

Mathiesen EB, Lindgren JU, Blomgren GG, Reinholt FP. Corrosion of modular hip prostheses. J Bone Joint Surg Br. 1991;73:569–575.PubMed

34.

Matthies AK, Racasan R, Bills P, Blunt L, Cro S, Panagiotidou A, Blunn G, Skinner J, Hart AJ. Material loss at the taper junction of retrieved large head metal-on-metal total hip replacements. J Orthop Res. 2013;31:1677–1685.PubMed

35.

Nassif NA, Nawabi DH, Stoner K, Elpers M, Wright T, Padgett DE. Taper design affects failure of large-head metal-on-metal total hip replacements. Clin Orthop Relat Res. 2014;472:564–571.PubMedCrossRef

36.

Rehmer A, Bishop NE, Morlock MM. Influence of assembly procedure and material combination on the strength of the taper connection at the head-neck junction of modular hip endoprostheses. Clin Biomech (Bristol, Avon). 2012;27:77–83.

37.

Rodrigues DC, Urban RM, Jacobs JJ, Gilbert JL. In vivo severe corrosion and hydrogen embrittlement of retrieved modular body titanium alloy hip-implants. J Biomed Mater Res B Appl Biomater. 2009;88:206–219.PubMedCentralPubMedCrossRef

38.

Scully WF, Teeny SM. Pseudotumor associated with metal-on-polyethylene total hip arthroplasty. Orthopedics. 2013;36:e666–670.PubMedCrossRef

39.

Svensson O, Mathiesen EB, Reinholt FP, Blomgren G. Formation of a fulminant soft-tissue pseudotumor after uncemented hip arthroplasty. A case report. J Bone Joint Surg Am. 1988;70:1238–1242.PubMed

40.

Urban RM, Jacobs JJ, Gilbert JL, Galante JO. Migration of corrosion products from modular hip prostheses. Particle microanalysis and histopathological findings. J Bone Joint Surg Am. 1994;76:1345–1359.PubMed

41.

Willert HG, Semlitsch M. Tissue reactions to plastic and metallic wear products of joint endoprostheses. Clin Orthop Relat Res. 1996;333:4–14.PubMed

Titel: What is the Trouble With Trunnions?
verfasst von: Christina I. Esposito, PhD
Timothy M. Wright, PhD
Stuart B. Goodman, MD, PhD
Daniel J. Berry, MD
The Clinical, Biological and Bioengineering Study Groups from the Carl T. Brighton Workshop
Publikationsdatum: 01.12.2014
Verlag: Springer US
Erschienen in: Clinical Orthopaedics and Related Research® / Ausgabe 12/2014
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-014-3746-z

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Background

Question/purposes

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 12/2014

Editorial Comment: ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements

CORR Insights®: Patient Activity After TKA Depends on Patient-specific Parameters

Time-dependent Changes After Latissimus Dorsi Transfer: Tenodesis or Tendon Transfer?

What Design and Material Factors Impact the Wear and Corrosion Performance in Total Elbow Arthroplasties?

CORR Insights®: An Analysis of References Used for the Orthopaedic In-Training Examination: What are Their Levels of Evidence and Journal Impact Factors?