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A review of wear debris in thumb base joint implants

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Abstract

Aim

Polymers and metals, such as polyethylene (PE) and cobalt chrome (CoCr), are common materials used in thumb-based joint implants, also known as CMC (Carpometacarpal) arthroplasty. The purpose of this review was to investigate the reported failure modes related to wear debris from these type of materials in CMC implants. The impact of wear debris on clinical outcomes of CMC implants was also examined. Potential adverse wear conditions and inflammatory particle characteristics were also considered.

Method

A literature search was performed using PRISMA guidelines and 55 studies were reviewed including 49 cohort studies and 6 case studies. Of the 55 studies, 38/55 (69%) focused on metal-on-polyethylene devices, followed by metal-on-metal (35%), and metal-on-bone (4%).

Results

The summarized data was used to determine the frequency of failure modes potentially related to wear debris from metals and/or polymers. The most commonly reported incidents potentially relating to debris were implant loosening (7.1%), osteolysis (1.2%) and metallosis (0.6%). Interestingly the reported mechanisms behind osteolysis and loosening greatly varied. Inflammatory reactions, while rare, were generally attributed to metallic debris from metal-on-metal devices.

Mechanisms of adverse wear conditions included implant malpositioning, over-tensioning, high loading for active patients, third-body debris, and polyethylene wear-through. No specific examination of debris particle characterization was found, pointing to a gap in the literature.

Conclusion

This review underscores the types of failure modes associated with wear debris in CMC implants. It was found that failure rates and adverse wear conditions of CMC implants of any design are low and the exact relationship between wear debris and implant incidences, such as osteolysis and loosening remains uncertain. The authors note that further research and specific characterization is required to understand the relationship between debris and implant failure.

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Authors and Affiliations

  1. Loci Orthopaedics, Galway, Ireland

    Fiona Mangan

  2. Drexel University, Philadelphia, PA, USA

    Hannah Spece & Steven M. Kurtz

  3. Gyroid, LLC, Haddonfield, NJ, USA

    Hannah Spece & Steven M. Kurtz

  4. Brown University, Providence, RI, USA

    Arnold-Peter C. Weiss

  5. Stanford University, Stanford, CA, USA

    Amy L. Ladd

  6. KU Leuven, Louvain, Belgium

    Filip Stockmans

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Appendices

Appendix 1

Search statement #1

Search: (((UHMW* OR POLYETHYLENE OR “Metal ions” OR “metal ion” OR Particl* OR Particulate OR Debris OR Metallosis OR Pain OR “Adverse local tissue” OR ALTR OR ARMD OR “Adverse Reaction to Metal Debris” OR “Adverse reactions to metal debris” OR Revision OR loosening) AND (thumb OR CMC OR CMCJ OR trapeziometacarpal OR TMCJ OR carpometacarpal) AND (implant* OR Arthroplasty OR “Joint replacement” OR prosthesis) NOT (silicon).


Search Detail:


(((“uhmw*”[All Fields] OR (“polyethene”[All Fields] OR “polyethylenes”[MeSH Terms] OR “polyethylenes”[All Fields] OR “polyethylene”[All Fields] OR “polyethylene”[MeSH Terms] OR “polyethylen”[All Fields]) OR “Metal ions”[All Fields] OR “metal ion”[All Fields] OR “particl*”[All Fields] OR (“particulate”[All Fields] OR “particulates”[All Fields]) OR “Debris”[All Fields] OR “Metallosis”[All Fields] OR (“pain”[MeSH Terms] OR “pain”[All Fields]) OR “Adverse local tissue”[All Fields] OR “ALTR”[All Fields] OR “ARMD”[All Fields] OR “Adverse Reaction to Metal Debris”[All Fields] OR “Adverse reactions to metal debris”[All Fields] OR (“revise”[All Fields] OR “revised”[All Fields] OR “revisers”[All Fields] OR “revises”[All Fields] OR “revising”[All Fields] OR “revision”[All Fields] OR “revisions”[All Fields]) OR (“loosen”[All Fields] OR “loosened”[All Fields] OR “loosening”[All Fields] OR “loosenings”[All Fields] OR “loosens”[All Fields])) AND “english”[Language] AND ((“thumb”[MeSH Terms] OR “thumb”[All Fields] OR “thumbs”[All Fields] OR “thumb s”[All Fields] OR “CMC”[All Fields] OR “CMCJ”[All Fields] OR “trapeziometacarpal”[All Fields] OR “TMCJ”[All Fields] OR “carpometacarpal”[All Fields]) AND “english”[Language]) AND ((“implant*”[All Fields] OR (“arthroplasty”[MeSH Terms] OR “arthroplasty”[All Fields] OR “arthroplasties”[All Fields]) OR “Joint replacement”[All Fields] OR (“prostheses and implants”[MeSH Terms] OR (“prostheses”[All Fields] AND “implants”[All Fields]) OR “prostheses and implants”[All Fields] OR “prosthesis”[All Fields])) AND “english”[Language]) AND (2001/01/01:3000/12/12[Date—Publication] AND “english”[Language])) NOT ((“silicon”[MeSH Terms] OR “silicon”[All Fields] OR “silicon s”[All Fields] OR “silicons”[All Fields]) AND ((english[Filter]) AND(2001:2021[pdat])).

Search statement #2

SU,TI,AB(UHMW* OR POLYETHYLENE OR “Metal ions” OR “metal ion” OR Particl* OR Particulate OR Debris OR Metallosis OR Pain OR “Adverse local tissue” OR ALTR OR ARMD OR “Adverse Reaction to Metal Debris” OR “Adverse reactions to metal debris” OR Revision OR loosening).

AND SU,TI,AB((thumb) NEAR/3 (CMC* OR carpometacarpal)) OR trapeziometacarpal OR TMCJ).

AND SU,TI,AB(implant* OR Arthroplasty OR “Joint replacement” OR prosthesis).

AND (pd(> 20,010,101)).

AND at.exact(“Article” OR “Government & Official Document” OR “Case Study” OR “Technical Report” OR “Report” OR “Literature Review”).

AND la.exact(“English”).

Appendix 2

See Table

Table 5 Filtered data used for summary of outcomes on a case-by-case basis
Full size table

5.

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Mangan, F., Spece, H., Weiss, AP.C. et al. A review of wear debris in thumb base joint implants. Eur J Orthop Surg Traumatol 34, 251–269 (2024). https://doi.org/10.1007/s00590-023-03622-x

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