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Clinical significance of corrosion of cemented femoral stems in metal-on-metal hips: a retrieval study

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Abstract

Purpose

The clinical significance of corrosion of cemented femoral stems is unclear. The purpose of this retrieval study was to: (1) report on corrosion at the stem-cement interface and (2) correlate these findings with clinical data.

Methods

We analysed cemented stems (n = 36) composed of cobalt-chromium (CoCr) and stainless steel (SS) in a series of revised metal-on-metal hips. We performed detailed inspection of each stem to assess the severity of corrosion at the stem-cement interface using a scale of 1 (low) to 5 (severe). We assessed the severity of corrosion at each stem trunnion and measured wear rates at the head taper and bearing surfaces. We used non-parametric tests to determine the significance of differences between the CoCr and SS stems in relation to: (1) pre-revision whole blood Co and Cr metal ion levels, (2) trunnion corrosion, (3) bearing surface wear and (4) taper material loss.

Results

The corrosion scores of CoCr stems were significantly greater than SS stems (p < 0.01). Virtually all stem trunnions in both alloy groups had minimal evidence of corrosion. The median pre-revision Co levels of implants with CoCr stems were significantly greater than the SS stems (p < 0.01). There was no significant difference in relation to pre-revision Cr levels (p = 0.521). There was no significant difference between the two stem types in relation to bearing wear (p = 0.926) or taper wear (p = 0.148).

Conclusions

Severe corrosion of cemented femoral stems is a common finding at our retrieval centre; surgeons should consider corrosion of CoCr stems as a potential source of metal ions when revising a hip.

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Acknowledgments

We are grateful for the support of Gwynneth Lloyd and Elizabeth Ellis for their coordination of the retrieval centre. Two authors received funding from the British Orthopaedic Association through an industry consortium of nine manufacturers: DePuy International Ltd (Leeds, UK), Zimmer GmbH (Winterthur, Switzerland), Smith & Nephew UK Ltd (Warwick, UK), Biomet UK Ltd (Bridgend, South Wales, UK), JRI Ltd (London, UK), Finsbury Orthopaedics Ltd (Leatherhead, UK), Corin Group PLC (Cirencester, UK), Mathys Orthopaedics Ltd (Alton, UK), and Stryker UK Ltd (Newbury, UK).

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Authors and Affiliations

  1. Institute of Orthopaedics and Musculoskeletal Science, University College London and the Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK

    Harry S. Hothi, Reshid Berber, Andreas C. Panagiotopoulos, Robert K. Whittaker, Camilla Rhead, John A. Skinner & Alister J. Hart

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  1. Harry S. Hothi
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  2. Reshid Berber
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  3. Andreas C. Panagiotopoulos
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  4. Robert K. Whittaker
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  5. Camilla Rhead
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  6. John A. Skinner
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  7. Alister J. Hart
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Correspondence to Harry S. Hothi.

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Hothi, H.S., Berber, R., Panagiotopoulos, A.C. et al. Clinical significance of corrosion of cemented femoral stems in metal-on-metal hips: a retrieval study. International Orthopaedics (SICOT) 40, 2247–2254 (2016). https://doi.org/10.1007/s00264-016-3116-4

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  • DOI: https://doi.org/10.1007/s00264-016-3116-4

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