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Proximal Component Modularity in THA—At What Cost?: An Implant Retrieval Study

  • Symposium: Retrieval Studies
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

While modular femoral heads have been used in THA for decades, a recent innovation is a second neck-stem taper junction. Clinical advantages include intraoperative adjustment of leg length, femoral anteversion, and easier revision, all providing flexibility to the surgeon; however, there have been reports of catastrophic fracture, cold welding, and corrosion and fretting of the modular junction.

Questions/purposes

We asked whether (1) the neck-stem junction showed the same degradation mechanisms, if any, as the head-neck junction, (2) the junction contributed to THA revision, (3) the alloy affected the degree of degradation, and (4) the trunion machine finish affected the degradation mechanisms.

Methods

We compared 57 retrievals from seven total hip modular designs, three cobalt-chromium-molybdenum and four titanium based: Bionik® (four), GMRS® (four), Margron® (22), Apex® (five), M-series® (five), ZMR® (two), and S-ROM® (15). Macroscopic inspection, microscopy, and micro-CT were conducted to determine the effects of materials and design.

Results

The cobalt-chromium-molybdenum components showed crevice corrosion and fretting of the neck-stem taper, whereas the titanium components had less corrosion; however, there were several cases of cold welding where disassembly could not be achieved in theater.

Conclusions

Even with modern taper designs and corrosion-resistant materials, corrosion, fretting, and particulate debris were observed to a greater extent in the second neck-stem junction. Titanium-based modular arthroplasty may lessen the degree of degradation, but cold welding of the components may occur.

Clinical Relevance

Degradation of the second junction contributed to 8 cases of metallosis and two cases of aseptic lymphocyte-laminated vascular-associated lesions contributing to revision.

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References

  1. Atwood SA, Patten EW, Bozic KJ, Pruitt LA, Ries MD. Corrosion-induced fracture of a double-modular hip prosthesis: a case report. J Bone Joint Surg Am. 2010;92:1522–1525.

    Article  PubMed  Google Scholar 

  2. Australian Orthopaedic Association. AOA National Joint Replacement Registry. Annual Report 2010. Available at: http://www.dmac.adelaide.edu.au/aoanjrr/documents/aoanjrrreport_2010.pdf. Accessed May 10, 2011.

  3. Berry DJ, Von Knoch M, Schleck CD, Harmsen WS. The cumulative long-term risk of dislocation after primary total hip arthroplasty, J Bone Joint Surg Am. 2004;86:9–14.

    PubMed  Google Scholar 

  4. Cameron HU. The proximal modular neck in THA: a bridge too far: opposes. Orthopedics. 2010;33:641.

    PubMed  Google Scholar 

  5. Collier JP, Mayor MB, Williams IR, Surprenant VA, Surprenant HP, Currier BH. The tradeoffs associated with modular hip prostheses. Clin Orthop Relat Res. 1995;311:91–101.

    PubMed  Google Scholar 

  6. Cook SD, Barrack R, Clemow AJ. Corrosion and wear at the modular interface of uncemented femoral stems. J Bone Joint Surg Br. 1994;76:68–72.

    PubMed  CAS  Google Scholar 

  7. Dunbar MJ. The proximal modular neck in THA: a bridge too far: affirms. Orthopedics. 2010;33:640.

    PubMed  Google Scholar 

  8. Fraitzl C, Buly R, Castellani L, Moya L. Corrosion at the sleeve-stem interface of a modular titanium alloy femoral component. J Bone Joint Surg Br. 2010;92(Suppl IV):514–515.

    Google Scholar 

  9. Fricker DC, Shivanath R. Fretting corrosion studies of universal femoral head prostheses and cone taper spigots. Biomaterials. 1990;11:495–500.

    Article  PubMed  CAS  Google Scholar 

  10. Frost RB, Sekel R, Kandel L. The engineering design of the MARGRON® femoral hip prosthesis system. J Eng Design. 2003;14:115–127.

    Article  Google Scholar 

  11. Garbuz DS, Tanzer M, Greidanus NV, Masri BA, Duncan CO. The John Charnley Award. Metal-on-metal resurfacing versus large diameter head metal-on-metal total hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res. 2010;468:318–325.

    Article  PubMed  Google Scholar 

  12. Goldberg JR, Gilbert JL, Jacobs JJ, Bauer TW, Paprosky W, Leurgans SA. Multicenter retrieval study of the taper interfaces of modular hip prosthesis. Clin Orthop Relat Res. 2002;401:149–161.

    Article  PubMed  Google Scholar 

  13. Jacobs JJ, Skipor AK, Patterson LM, Hallab NH, 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  CAS  Google Scholar 

  14. 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  Google Scholar 

  15. Khan MA, Williams RL, Williams DF. In-vitro corrosion and wear of titanium alloys in the biological environment. Biomaterials. 1996;17:2117–2126.

    Article  PubMed  CAS  Google Scholar 

  16. Kop AM, Swarts E. Corrosion of a hip stem with a modular neck taper junction: a retrieval study of 16 cases. J Arthroplasty. 2009;24:1019–1023.

    Article  PubMed  Google Scholar 

  17. Kretzer JP, Jakubowitz E, Krachler M, Thomsen M, Heisel C. Metal release and corrosion effects of modular neck total hip arthroplasty. Int Orthop. 2009;33:1531–1536.

    Article  PubMed  Google Scholar 

  18. McTighe T. Cementless modular stems. 2002. Joint Implant Surgery and Research Foundation. Available at: http://www.jisrf.org/pdf files/Updated0402.pdf. Accessed May 10, 2011.

  19. Pallini F, Cristofolini L, Traina F, Toni A. Modular hip stems: determination of disassembly force of a neck-stern coupling. Artif Organs. 2007;31:166–170.

    Article  PubMed  Google Scholar 

  20. Patntirapong S, Habibovic P, Hauschka PV. Effects of soluble cobalt and cobalt incorporated into calcium phosphate layers on osteoclast differentiation and activation. Biomaterials. 2009;30:548–555.

    Article  PubMed  CAS  Google Scholar 

  21. Salvati EA, Lieberman JR, Huk OL, Evans BG. Complications of femoral and acetabular modularity. Clin Orthop Relat Res. 1995;319:85–93.

    PubMed  Google Scholar 

  22. Schramm M, Wirtz DC, Holzwarth U, Pitto RP. The Morse taper junction in modular revision hip replacement—a biomechanical and retrieval analysis. Biomed Tech (Berl). 2000;45:105–109.

    Article  CAS  Google Scholar 

  23. Sporer SM, Della Valle C, Jacobs J, Wimmer M. A case of disassociation of a modular femoral neck trunion in total hip arthroplasty. J Arthroplasty. 2006;21:918–921.

    Article  PubMed  Google Scholar 

  24. US Food and Drug Administration. MAUDE database. 2009. Available at: www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm. Accessed May 10, 2011.

  25. Viceconti M, Baleani M, Squarzoni S, Toni A. Fretting wear in a modular neck hip prosthesis. J Biomed Mater Res. 1997;35:207–216.

    Article  PubMed  CAS  Google Scholar 

  26. Viceconti M, Ruggeri O, Toni A, Giunti A. Design-related fretting in modular neck hip prosthesis. J Biomed Mater Res. 1996;30:181–186.

    Article  PubMed  CAS  Google Scholar 

  27. Willert HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Köster G, Lohmann CH. Metal-on-metal hypersensitivity in patients with artificial hip joints: a clinical and histomorphological study. J Bone Joint Surg Am. 2005;87:28–36.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors thank all orthopaedic surgeons in Western Australia who continue to support the Royal Perth Hospital Retrieval Service and consistently send retrievals for analysis. We also acknowledge assistance from Dr David Morrison and Dr Andrew Campbell with regard to the micro-CT image manipulation.

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Authors and Affiliations

  1. Department of Medical Engineering and Physics, Royal Perth Hospital, Wellington Street, Perth, 6000, Western Australia

    A. M. Kop PhD, C. Keogh DipAppSci & E. Swarts BSc

Authors
  1. A. M. Kop PhD
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  2. C. Keogh DipAppSci
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  3. E. Swarts BSc
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Corresponding author

Correspondence to E. Swarts BSc.

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Kop, A.M., Keogh, C. & Swarts, E. Proximal Component Modularity in THA—At What Cost?: An Implant Retrieval Study. Clin Orthop Relat Res 470, 1885–1894 (2012). https://doi.org/10.1007/s11999-011-2155-9

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  • DOI: https://doi.org/10.1007/s11999-011-2155-9

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