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

  • Symposium: Papers Presented at the 2011 Meeting of the International Hip Society
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

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.

Questions/purposes

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Department of Orthopaedics, Otto-von-Guericke University, Leipziger Str 44, 39108, Magdeburg, Germany

    Heiko Meyer MD, Tina Mueller BS, Kathrin Chamaon PhD & Christoph H. Lohmann MD

  2. University of Applied Sciences, Magdeburg-Stendal, Germany

    Gesine Goldau BS

  3. Department of Orthopaedics, Loretto Hospital, Freiburg, Germany

    Marcel Ruetschi MD

Authors
  1. Heiko Meyer MD
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  2. Tina Mueller BS
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  6. Christoph H. Lohmann MD
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Corresponding author

Correspondence to Christoph H. Lohmann MD.

Additional information

This study was supported by a generous grant from the ENDO-Stiftung, Hamburg, Germany (HM, CHL).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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Meyer, H., Mueller, T., Goldau, G. et al. Corrosion at the Cone/Taper Interface Leads to Failure of Large-diameter Metal-on-metal Total Hip Arthroplasties. Clin Orthop Relat Res 470, 3101–3108 (2012). https://doi.org/10.1007/s11999-012-2502-5

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  • DOI: https://doi.org/10.1007/s11999-012-2502-5

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