Clinical Orthopaedics and Related Research®

, Volume 470, Issue 11, pp 3101–3108 | Cite as

Corrosion at the Cone/Taper Interface Leads to Failure of Large-diameter Metal-on-metal Total Hip Arthroplasties

  • Heiko Meyer
  • Tina Mueller
  • Gesine Goldau
  • Kathrin Chamaon
  • Marcel Ruetschi
  • Christoph H. LohmannEmail author
Symposium: Papers Presented at the 2011 Meeting of the International Hip Society



Metal-on-metal (MoM) THAs have reduced wear rates compared with metal-on-polyethylene. However, elevated serum metal ion levels and pseudotumors have been reported in large MoM articulations.


We therefore determined (1) if corrosion occurred at the cone/taper interface leading to instability in patients with large-diameter THAs; (2) how patients presented clinically and radiographically; (3) if adverse periprosthetic tissue reactions occurred; (4) whether metal was released from the implants into the periprosthetic tissues; and (5) if head size correlated with metal release.


We reviewed 114 patients who had revisions of large-diameter head MoM articulations. Mean time of implantation was 46 months. To identify adverse reactions and particle load, tissues were stained by hematoxylin and eosin and CD3/CD20/CD68 antibodies. Periprosthetic tissues were analyzed for metal content and distribution in different regions. Electrochemical reactions between the stem and adapter were investigated by a minicell electrode.


Electrochemical studies on the stem and the head adapter showed a risk for galvanic corrosion. Ninety-four percent of patients had instability at the cone/taper interface. All patients presented with early clinical symptoms; 59 patients had radiographic signs of loosening. One hundred four patients had foreign body reactions and necrosis. The largest amounts of metal released were titanium or iron. We found no correlation between head size and metal ion release.


These findings suggest that in modular cone/taper connections, friction of the MoM articulations may cause failure of the cone/taper interface leading to galvanic corrosion and loosening. It is unclear whether the design of this MoM system provides sufficient stability at the taper.


Head Size Foreign Body Reaction Groin Pain Galvanic Corrosion Periprosthetic Tissue 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Dr. B. Feuerstein and Dr. G. Krause for technical support in the analysis of metal contents, Mrs. Carolin Hertzsch for help with the histological stainings, Dr. F. Awiszus for statistical analyses, and Dr. D. Brauers for providing demographic data of the patients.


  1. 1.
    Amstutz HC, Campbell P, Kossovsky N, Clarke IC. Mechanism and clinical significance of wear debris-induced osteolysis. Clin Orthop Relat Res. 1992;276:7–18.PubMedGoogle Scholar
  2. 2.
    Antoniou J, Zukor DJ, Mwale F, Minarik W, Petit A, Huk OL. Metal ion levels in the blood of patients after hip resurfacing: a comparison between twenty-eight and thirty-six-millimeter-head metal-on-metal prostheses. J Bone Joint Surg Am. 2008;90(Suppl 3):142–148.PubMedCrossRefGoogle Scholar
  3. 3.
    Bach CM, Biedermann R, Goebel G, Mayer E, Rachbauer F. Reproducible assessment of radiolucent lines in total knee arthroplasty. Clin Orthop Relat Res. 2005;434:183–188.PubMedCrossRefGoogle Scholar
  4. 4.
    Boehler N. Experiences with metal on metal components in THR. Acta Orthop Belg. 1997;63(Suppl 1):96–97.PubMedGoogle Scholar
  5. 5.
    Bolland BJ, Culliford DJ, Langton DJ, Millington JP, 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.PubMedCrossRefGoogle Scholar
  6. 6.
    Clarke IC, Good V, Williams P, Schroeder D, Anissian L, Stark A, Oonishi H, Schuldies J, Gustafson G. Ultra-low wear rates for rigid-on-rigid bearings in total hip replacements. Proc Inst Mech Eng H. 2000;214:331–347.PubMedCrossRefGoogle Scholar
  7. 7.
    Coleman RF, Herrington J, Scales JT. Concentration of wear products in hair, blood and urine after total hip replacement. BMJ. 1973;1:527–529.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedGoogle Scholar
  9. 9.
    Dorr LD, Long WT, Sirianni L, Campana M, Wan Z. The argument for the use of Metasul as an articulation surface in total hip replacement. Clin Orthop Relat Res. 2004;429:80–85.PubMedCrossRefGoogle Scholar
  10. 10.
    Garbuz DS, Tanzer M, Greidanus NV, Masri BA, Duncan CP. The John Charnley Award: Metal-on-metal hip resurfacing versus large-diameter head metal-on-metal total hip arthroplasty: a randomized clinical trial. Clin Orthop Relat Res. 2010;468:318–325.PubMedCrossRefGoogle Scholar
  11. 11.
    Gilbert JL, Buckley CA, Jacobs JJ. In vivo corrosion of modular hip prosthesis components in mixed and similar metal combinations. The effect of crevice, stress, motion, and alloy coupling. J Biomed Mater Res. 1993;27:1533–1544.PubMedCrossRefGoogle Scholar
  12. 12.
    Gilbert RE, Cheung G, Carrothers AD, Meyer C, Richardson JB. Functional results of isolated femoral revision of hip resurfacing arthroplasty. J Bone Joint Surg Am. 2010;92:1600–1604.PubMedCrossRefGoogle Scholar
  13. 13.
    Goldberg JR, Gilbert JL. In vitro corrosion testing of modular hip tapers. J Biomed Mater Res B Appl Biomater. 2003;64:78–93.PubMedCrossRefGoogle Scholar
  14. 14.
    Gray MH, Talbert ML, Talbert WM, Bansal M, Hsu A. Changes seen in lymph nodes draining the sites of large joint prostheses. Am J Surg Pathol. 1989;13:1050–1056.PubMedCrossRefGoogle Scholar
  15. 15.
    Grupp TM, Weik T, Bloemer W, Knaebel HP. Modular titanium alloy neck adapter failures in hip replacement—failure mode analysis and influence of implant material. BMC Musculoskelet Disord. 2010;11:3.PubMedCrossRefGoogle Scholar
  16. 16.
    Hing CB, Back DL, Bailey M, Young DA, Dalziel RE, Shimmin AJ. The results of primary Birmingham hip resurfacings at a mean of five years. An independent prospective review of the first 230 hips. J Bone Joint Surg Br. 2007;89:1431–1438.PubMedCrossRefGoogle Scholar
  17. 17.
    Howie DW. Tissue response in relation to type of wear particles around failed hip arthroplasties. J Arthroplasty. 1990;5:337–348.PubMedCrossRefGoogle Scholar
  18. 18.
    Jacobs JJ, Skipor AK, Doorn PF, Campbell P, Schmalzried TP, Black J, Amstutz HC. Cobalt and chromium concentrations in patients with metal-on-metal total hip replacements. Clin Orthop Relat Res. 1996;329(Suppl):S256–263.PubMedCrossRefGoogle Scholar
  19. 19.
    Jacobs JJ, Urban RM, Gilbert IL, Skipor AK, Black J, Jasty M, Galante JO. Local and distant products from modularity. Clin Orthop Relat Res. 1995;319:94-105.PubMedGoogle Scholar
  20. 20.
    Jasty M, Jiranek W, Harris WH. Acrylic fragmentation in total hip replacements and its biological consequences. Clin Orthop Relat Res. 1992;285:116–128.PubMedGoogle Scholar
  21. 21.
    Kim KJ, Rubash HE, Wilson SC, D’Antonio JA, McClain EJ. A histologic and biochemical comparison of the interface tissues in cementless and cemented hip prostheses. Clin Orthop Relat Res. 1993;287:142–152.PubMedGoogle Scholar
  22. 22.
    Kirkpatrick CJ, Alves A, Köhler H, Kriegsmann J, Bittinger F, Otto M, Williams DF, Eloy R. Biomaterial-induced sarcoma: a novel model to study preneoplastic change. Am J Pathol. 2000;156:1455–1467.PubMedCrossRefGoogle Scholar
  23. 23.
    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.PubMedCrossRefGoogle Scholar
  24. 24.
    Langkamer VG, Case CP, Heap P, Taylor A, Collins C, Pearse M, Solomon L. Systemic distribution of wear debris after hip replacement. A cause for concern? J Bone Joint Surg Br. 1992;74:831–839.PubMedGoogle Scholar
  25. 25.
    Langton DJ, Jameson SS, Joyce TJ, Gandhi JN, Sidaginamale R, Mereddy P, Lord J, Nargol AV. Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br. 2011;93:1011–1016.PubMedCrossRefGoogle Scholar
  26. 26.
    Langton DJ, Joyce TJ, Jameson SS, Lord J, Van Orsouw M, Holland JP, Nargol AV, De Smet KA. Adverse reaction to metal debris following hip resurfacing: the influence of component type, orientation and volumetric wear. J Bone Joint Surg Br. 2011;93:164–171.PubMedCrossRefGoogle Scholar
  27. 27.
    Lavigne M, Belzile EL, Roy A, Morin F, Amzica T, Vendittoli PA. Comparison of whole-blood metal ion levels in four types of metal-on-metal large-diameter femoral head total hip arthroplasty: the potential influence of the adapter sleeve. J Bone Joint Surg Am. 2011;93(Suppl 2):128–136.PubMedCrossRefGoogle Scholar
  28. 28.
    Lee JM, Salvati EA, Betts F, DiCarlo EF, Doty SB, Bullough PG. Size of metallic and polyethylene debris particles in failed cemented total hip replacements. J Bone Joint Surg Br. 1992;74:380–384.PubMedGoogle Scholar
  29. 29.
    Lohmann CH, Nuechtern JV, Willert HG, Junk-Jantsch S, Ruether W, Pflueger G. Hypersensitivity reactions in total hip arthroplasty. Orthopedics. 2007;30:760–761.PubMedGoogle Scholar
  30. 30.
    Long WT, Dastane M, Harris MJ, Wan Z, Dorr LD. Failure of the Durom Metasul acetabular component. Clin Orthop Relat Res. 2010;468:400–405.PubMedCrossRefGoogle Scholar
  31. 31.
    Mahendra G, Pandit H, Kliskey K, Murray DW, Gill HS, Athanasou N. Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties—relation to implant failure and pseudotumor formation. Acta Orthop. 2009;80:653–659.PubMedCrossRefGoogle Scholar
  32. 32.
    Mertl P, Boughebri O, Havet E, Triclot P, Lardanchet JF, Gabrion A. Large diameter head metal-on-metal bearings total hip arthroplasty: preliminary results. Orthop Traumatol Surg Res. 2010;96:14–20.PubMedCrossRefGoogle Scholar
  33. 33.
    Pandit H, Glyn-Jomes S, McLardy-Smith P, Gundle R, Whitwell D, Gibbons CLM, Ostlere S, Athanasou N, Gill HS, Murray DW. Pseudotumors associated with metal-on-metal hip resurfacings. J Bone Joint Surg Br. 2008;90:847–851.PubMedCrossRefGoogle Scholar
  34. 34.
    Pandit H, Vlychou M, Whitwell D, Crook D, Luqmani R, Ostlere S, Murray DW, Athanasou N. Necrotic granulomatous pseudotumors in bilateral resurfacing hip arthroplasties: evidence for a type IV immune response. Virchows Arch. 2008;453:429–534.CrossRefGoogle Scholar
  35. 35.
    Revell PA. Tissue reactions to joint prostheses and the products of wear and corrosion. Curr Top Pathol. 1982;71:73–101.PubMedCrossRefGoogle Scholar
  36. 36.
    Savarino L, Granchi D, Ciapetti G, Cenni E, Nardi Pantoli A, Rotini R, Veronesi CA, Baldini N, Giunti A. Ion release in patients with metal-on-metal hip bearings in total joint replacement: a comparison with metal-on-polyethylene bearings. J Biomed Mater Res. 2002;63:467–474.PubMedCrossRefGoogle Scholar
  37. 37.
    Shimmin AJ, Walter WL, Esposito C. The influence of the size of the component on the outcome of resurfacing arthroplasty of the hip: a review of the literature. J Bone Joint Surg Br. 2010;92:469–476.PubMedGoogle Scholar
  38. 38.
    Spaehn H. Electrochemical corrosion in aqueous solutions without simultaneous load. In: Kunze E, ed. Corrosion and Corrosion Protection, Volume 1: Basics and Scientific Principles [in German]. Berlin, Germany: Wiley-VCH; 2001.Google Scholar
  39. 39.
    Stea S, Visentin M, Granchi D, Cenni E, Ciapetti G, Sudanese A, Toni A. Apoptosis in peri-implant tissue. Biomaterials. 2000;21:1393–1398.PubMedCrossRefGoogle Scholar
  40. 40.
    Sunderman FW Jr, Hopfer SM, Swift T, Rezuke WN, Ziebka L, Highman P, Edwards B, Folcik M, Gossling HR. Cobalt, chromium, and nickel concentrations in body fluids of patients with porous-coated knee or hip prostheses. J Orthop Res. 1989;7:307–315.PubMedCrossRefGoogle Scholar
  41. 41.
    Weber BG. Experience with the Metasul total hip bearing system. Clin Orthop Relat Res. 1996;329(Suppl):69–77.CrossRefGoogle Scholar
  42. 42.
    Willert HG, Buchhorn GH, Fayazzi A, Flury R, Windler M, Koester G, Lohmann CH. Metal/metal bearings and hypersensitivity in artifical hip joint—a clinical and histomorphological study. J Bone Joint Surg Am. 2005;87:28–36.PubMedCrossRefGoogle Scholar
  43. 43.
    Willert HG, Buchhorn GH, Göbel D, Köster G, Schaffner S, Schenk R, Semlitsch M. Wear behavior and histopathology of classic cemented metal on metal hip endoprostheses. Clin Orthop Relat Res. 1996;329(Suppl):S160–S186.PubMedCrossRefGoogle Scholar
  44. 44.
    Willert HG, Semlitsch M. Reactions of the articular capsule to wear products of artificial joint prostheses. J Biomed Mater Res. 1977;11:157–164.PubMedCrossRefGoogle Scholar
  45. 45.
    Witzleb WC, Ziegler J, Krummenauer F, Neumeister V, Guenther KP. Exposure to chromium, cobalt and molybdenum from metal-on-metal total hip replacement and hip resurfacing arthroplasty. Acta Orthop. 2006;77:697–705.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Heiko Meyer
    • 1
  • Tina Mueller
    • 1
  • Gesine Goldau
    • 2
  • Kathrin Chamaon
    • 1
  • Marcel Ruetschi
    • 3
  • Christoph H. Lohmann
    • 1
    Email author
  1. 1.Department of OrthopaedicsOtto-von-Guericke UniversityMagdeburgGermany
  2. 2.University of Applied SciencesMagdeburg-StendalGermany
  3. 3.Department of OrthopaedicsLoretto HospitalFreiburgGermany

Personalised recommendations