Revision for taper corrosion at the neck-body junction following total hip arthroplasty: pearls and pitfalls

  • Mitchell C. Weiser
  • Darwin D. ChenEmail author
Hip: Metal-on-Metal (J Cooper, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Hip: Metal-on-Metal


The management of the patient with a recalled, modular neck-body total hip arthroplasty can be complex, as it involves a combination of clinical, technical, and medicolegal challenges. Management begins with a thorough history and physical exam, radiographic evaluation, infection workup, and serum metal ion levels. Three-dimensional imaging is obtained based on patient symptomatology and metal ion levels and is used to evaluate for the presence of an adverse local tissue response as well as the integrity of the existing soft tissue envelope. The decision to perform revision surgery is based on a combination of patient symptomatology, laboratory values, and imaging findings. Revision surgery involves the entire armamentarium of femoral revision techniques, and the acetabulum may need to be revised at the surgeon’s discretion. The femoral implant can often be removed without disrupting the femoral bone envelope; however, the surgeon should have a low threshold to perform an extended trochanteric osteotomy.


Corrosion Modular neck Revision hip arthroplasty Adverse local tissue reaction 


Compliance with ethical standards

Conflict of interest

Mitchell C. Weiser reports that he is a member of the AAOS Biomedical Engineering Committee.

Darwin D. Chen reports personal fees from KCI Acelity, outside the submitted work.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Older J. Charnley low-friction arthroplasty: a worldwide retrospective review at 15 to 20 years. J Arthroplasty. 2002;17(6):675–80.CrossRefPubMedGoogle Scholar
  2. 2.••
    Cooper HJ, Urban RM, Wixson RL, Meneghini RM, Jacobs JJ. Adverse local tissue reaction arising from corrosion at the femoral neck-body junction in a dual taper stem with a cobalt-chromium modular neck. J Bone Joint Surg Am. 2013;95(10):865–2. Article is of major importance as it was the first to describe the clinical presentation and intra-operative findings of dual taper modular THA corrosion in the Stryker Rejuvenate and ABGII stems. It also identified mechanically assisted crevice corrosion as the likely mechanism of failure in the dual modular stem design.PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.•
    Molloy DO, Munir S, Jack CM, Cross MB, Walter WL, Walter Sr WK. Fretting and corrosion in modular-neck total hip arthroplasty femoral stems. J Bone Joint Surg Am. 2014;96(6):488–93. Article is of importance as it confirmed the clinical, radiographic, and intra-operative findings of neck-stem mechanically assisted corrosion in the Stryker ABGII femoral stem.CrossRefPubMedGoogle Scholar
  4. 4.•
    Meftah M, Haleem AM, Burn MB, Smith KM, Incavo SJ. Early corrosion-related failure of the rejuvenate modular total hip replacement system. J Bone Joint Surg Am. 2014;96(6):481–7. Article is of importance as it confirmed the clinical, radiographic, and intra-operative findings of neck-stem mechanically assisted corrosion in the Stryker Rejuvenate femoral stem.CrossRefPubMedGoogle Scholar
  5. 5.
    Silverton CD, Jacobs JJ, Devitt JW, Cooper HJ. Midterm results of a femoral stem with a modular neck design: clinical outcomes and metal ion analysis. J Arthroplasty. 2014;29(9):1768–73.CrossRefPubMedGoogle Scholar
  6. 6.
    De Martino I, Assini JB, Elpers ME, Wright TM, Westrich GH. Corrosion and fretting of a modular hip system: a retrieval analysis of 60 rejuvenate stems. J Arthroplasty. 2015;30(8):1470–5.CrossRefPubMedGoogle Scholar
  7. 7.
    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(7):1019–23.CrossRefPubMedGoogle Scholar
  8. 8.
    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;401:149–61.CrossRefPubMedGoogle Scholar
  9. 9.
    United States Food and Drug Administration. Stryker Initiated Voluntary Product Recall of Modular-Neck Stems: Action Specific to Rejuvenate and ABG II Modular Neck Stems. Accessed 16 September 2015
  10. 10.
    Bozic KJ, Rubash HE. The painful total hip replacement. Clin Orthop Relat Res. 2004;420:18–25.CrossRefPubMedGoogle Scholar
  11. 11.
    Tower SS. Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report. J Bone Joint Surg Am. 2010;92(17):2847–51.CrossRefPubMedGoogle Scholar
  12. 12.
    Bradbery SM, Wilkinson JM, Ferner RE. Systemic toxicity related to metal hip prostheses. Clin Toxicol (Phila). 2014;52(8):837–47.CrossRefGoogle Scholar
  13. 13.
    Cooper HJ, Della Valle CJ, Berger RA, Tetrault M, Paprosky WG, Sporer SM, et al. 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(18):1655–61.PubMedGoogle Scholar
  14. 14.••
    Yi PH, Cross MB, Moric M, Levine BR, Sporer SM, Paprosky WG, et al. Do serologic and synovial tests help diagnose infection in revision hip arthroplasty with metal-on-metal bearings or corrosion? Clin Orthop Relat Res. 2015;473(2):498–505. Article is of major importance as it outlines the diagnostic difficulty in differentiating PJI in patients with corroded modular neck femoral stems and makes a cutoff recommendations for cell counts indicative of PJI in these cases.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.•
    Pivec R, Meneghini RM, Hozack WJ, Westrich GH, Mont MA. Modular taper junction corrosion and failure: how to approach a recalled total hip arthroplasty implant. J Arthroplasty. 2014;29(1):1–6. This article is of importance as it provides an algorithm for evaluating patients presenting with corroded modular neck femoral stems.CrossRefPubMedGoogle Scholar
  16. 16.
    Vundelinckx BJ, Verhelst LA, De Schepper J. Taper corrosion in modular hip prostheses: analysis of serum metal ions in 19 patients. J Arthroplasty. 2013;28(7):1218–23.CrossRefPubMedGoogle Scholar
  17. 17.
    Walsh CP, Hubbard JC, Nessler JP, Markel DC. Revision of recalled modular neck rejuvenate and ABG femoral implants. J Arthroplasty. 2015;30(5):822–6.CrossRefPubMedGoogle Scholar
  18. 18.•
    Barlow BT, Assini J, Boles J, Lee YY, Westrich GH. Short-term metal ion trends following removal of recalled modular neck femoral stems. J Arthroplasty. 2015;30(7):1191–6. Article is of importance as it provides a timeline for serum ion normalization following revision of a corroded modular neck femoral stem.CrossRefPubMedGoogle Scholar
  19. 19.••
    Kwon YM, Fehring TK, Lombardi AV, Barnes CL, Cabanela ME, Jacobs JJ. Risk stratification algorithm for management of patients with dual modular taper total hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the Hip Society. J Arthroplasty. 2014;29(11):2060–4. Article is of major importance as it provides detailed outlines for stratifying patients with corroded modular neck femoral stems into low, medium, and high-risk patients. It also provides treatment and follow up recommendations for each of these risk classes.CrossRefPubMedGoogle Scholar
  20. 20.•
    Levine BR, Hsu AR, Skipor AK, Hallab NJ, Paprosky WG, Galante JO, et al. Ten-year outcome of serum metal ion levels after primary total hip arthroplasty: a concise follow-up of a previous report. J Bone Joint Surg Am. 2013;90(5):512–8. This article is of importance as it establishes expected normal serum ion values out to 10 years of follow up after receiving a modern modular head femoral stem.CrossRefGoogle Scholar
  21. 21.•
    Kwon YM. Cross-sectional imaging in evaluation of soft tissue reaction secondary to metal debris. J Arthroplasty. 2014;29(4):653–6. Article is of importance as it provides a good review of the available cross sectional imaging modalities and associated findings in the evaluation of the corroded modular femoral stem.CrossRefPubMedGoogle Scholar
  22. 22.
    Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am. 2001;83-A(3):428–36.PubMedGoogle Scholar
  23. 23.
    Thyssen JP, Jakobsen SS, Engkilde K, Johansen JD, Søballe K, Menné T. The association between metal allergy, total hip arthroplasty, and revision. Acta Orthop. 2009;80(6):646–52.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Granchi D, Cenni E, Guinti A, Baldini N. Metal hypersensitivity testing in patients undergoing joint replacement: a systematic review. J Bone Joint Surg (Br). 2012;94(8):1126–34.CrossRefGoogle Scholar
  25. 25.
    Mitchelson AJ, Wilson CJ, Mihalko WM, Grupp TM, Manning BT, Dennis DA, et al. Biomaterial hypersensitivity: is it real? Supportive evidence and approach considerations for metal allergic patients following total knee arthroplasty. Biomed Res Int. 2015;2015:137287.PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    Thomas P, Braathen LR, Dörig M, Auböck J, Nestle F, Werfel T, et al. Increased metal allergy with failed metal-on-metal hip arthroplasty and peri-implant T-lymphocytic inflammation. Allergy. 2009;64(8):1157–65.CrossRefPubMedGoogle Scholar
  27. 27.
    Willer HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Köster G, et al. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am. 2005;87(1):28–36.CrossRefGoogle Scholar
  28. 28.
    Schalock PC, Menné T, Johansem JD, Taylor JS, Maiback HI, Lidén C, et al. Hypersensitivity reactions to metallic implants-diagnostic algorithm and suggested patch test series for clinical use. Contact Dermatitis. 2012;66(1):4–19.CrossRefPubMedGoogle Scholar
  29. 29.
    Atanaskova Mesinkovska N, Tellez A, Molina L, Honari G, Sood A, Barsoum W, et al. The effect of patch testing on surgical practices and outcomes in orthopaedic patients with metal implants. Arch Dermatol. 2012;148(6):687–93.PubMedGoogle Scholar
  30. 30.
    Vermes C, Kuzsner J, Bárdos T, Than P. Prospective analysis of human leukocyte functional tests reveals metal sensitivity in patients with hip implant. J Orthop Surg Res. 2013;8:12.PubMedCentralCrossRefPubMedGoogle Scholar
  31. 31.
    Hallab NJ, Mikecz K, Jacobs JJ. A triple assay technique for the evaluation of metal-induced, delayed-type hypersensitivity responses in patients with or receiving total joint arthroplasty. J Biomed Mater Res. 2000;53(5):480–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Metal sensitivity testing and associated total joint outcomes. Accessed 30 September 2015.
  33. 33.•
    Munro JT, Masri BA, Duncan CP, Garbuz DS. High complication rate after revision of large-head metal-on-metal total hip arthroplasty. Clin Orthop Relat Res. 2014;472(2):523–8. This article is of importance as it outlines the complications following metal-on-metal revision.PubMedCentralCrossRefPubMedGoogle Scholar
  34. 34.•
    Wyles CC, Van Demark 3rd RE, Sierra RJ, Trousdale RT. High rate of infection after aseptic revision of failed metal-on-metal total hip arthroplasty. Clin Orthop Relat Res. 2014;472(2):509–16. This article is of importance as it outlines the complications following metal-on-metal revision.PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.•
    Shah RP, Kamath AF, Saxena V, Garino JP. Steinman pin technique for the removal of well fixed femoral stems. J Arthroplasty. 2013;28(2):292–5. This article is of importance as it is the original description of the Steinman Pin Surgical Technique.CrossRefPubMedGoogle Scholar
  36. 36.
    Younger TI, Bradford MS, Magnus RE, Paprosky WG. Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty. J Arthroplasty. 1995;10(3):329–38.CrossRefPubMedGoogle Scholar
  37. 37.
    Mardones R, Gonzalez C, Cabanela ME, Trousdale RT, Berry DJ. Extended femoral osteotomy for revision of hip arthroplasty: results and complications. J Arthroplasty. 2005;20(1):79–83.CrossRefPubMedGoogle Scholar
  38. 38.
    Miner TM, Momberger NG, Chong D, Paprosky WL. The extended trochanteric osteotomy in revision hip arthroplasty: a critical review of 166 cases at mean 3-year, 9-month follow up. J Arthroplasty. 2001;16(8 Suppl 1):188–94.CrossRefPubMedGoogle Scholar
  39. 39.
    Cooper HJ. The local effects of metal corrosion in total hip arthroplasty. Orthop Clin N Am. 2014;45(1):9–18.CrossRefGoogle Scholar
  40. 40.
    Yun AG, Padgett D, Pellicci P, Dorr LD. Constrained acetabular liners: mechanisms of failure. J Arthroplasty. 2005;20(4):536–41.CrossRefPubMedGoogle Scholar
  41. 41.
    Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV. Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res. 2012;470(7):1907–16.PubMedCentralCrossRefPubMedGoogle Scholar
  42. 42.
    Plummer DR, Haughom BD, Della Valle CJ. Dual mobility in total hip arthroplasty. Orthop Clin N Am. 2014;45(1):1–8.CrossRefGoogle Scholar
  43. 43.
    Lachiewicz PF, Watters TS. The use of dual-mobility components in total hip arthroplasty. J Am Acad Orthop Surg. 2012;20(8):481–6.CrossRefPubMedGoogle Scholar
  44. 44.
    Philippot R, Boyer B, Farizon F. Intraprosthetic dislocation: a specific complication of the dual mobility system. Clin Orthop Relat Res. 2013;471(3):965–70.PubMedCentralCrossRefPubMedGoogle Scholar
  45. 45.
    Hailer NP, Weiss RJ, Stark A, Kärrholm J. Dual-mobility cups for revision due to instability are associated with a low rate of re-revision due to dislocation: 228 patients from the Swedish hip arthroplasty register. Acta Orthop. 2012;83(6):566–71.PubMedCentralCrossRefPubMedGoogle Scholar
  46. 46.
    Matsen Ko LJ, Pollag KE, Yoo JY, Sharkey PF. Serum metal ion levels following total hip arthroplasty with modular dual mobility components. J Arthroplasty. 2015.Google Scholar
  47. 47.
    Gascoyne TC, Dyrkacz RM, Turgeon TR, Burnell CD, Wyss UP, Brandt JM. Corrosion on the acetabular liner taper from retrieved modular metal-on-metal total hip replacements. J Arthroplasty. 2014;29(10):2049–52.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkUSA

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