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Taper Design Affects Failure of Large-head Metal-on-metal Total Hip Replacements

  • Symposium: 2013 Hip Society Proceedings
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Large-head metal-on-metal (MoM) hip arthroplasties have demonstrated poor survival. Damage at the taper-trunnion junction is a contributing factor; however, the influence of junction design is not well understood.

Questions/purposes

(1) Does taper type affect fretting, corrosion, and volumetric wear at the junction? (2) Do taper types have different wear patterns? (3) Does larger offset or head diameter increase fretting, corrosion, and wear? (4) Is the extent of fretting and corrosion associated with earlier failure?

Methods

Taper damage in 40 retrieved heads was subjectively graded for fretting and corrosion, and wear was determined with high-resolution confocal measurement. Taper types (11/13, 12/14, and Type 1) differed by angle, distal diameter, and contact length; Type 1 were thinnest and 11/13 had longer contact lengths.

Results

Fretting scores were higher in 11/13 than in Type 1 tapers. Volumetric wear and wear rates did not differ among types. Uniform, circumferential, and longitudinal wear patterns were observed in all types, but fretting, corrosion, and wear did not differ among the patterns. Head diameter and lateral offset did not correlate with fretting, corrosion, or wear. No correlation was found between fretting, corrosion, or wear and length of implantation.

Conclusions

In general, thicker tapers with longer contact lengths were associated with greater fretting scores, whereas no relationship was found among the three designs for corrosion scores or volumetric wear. This finding suggests that trunnion diameter and engagement length are important factors to consider when improving taper-trunnion junction design.

Level of Evidence

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank Stephanie Tow for her assistance with this project.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    Nader A. Nassif MD, Danyal H. Nawabi MD & Douglas E. Padgett MD

  2. Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA

    Kirsten Stoner MEng, Marcella Elpers BS & Timothy Wright PhD

Authors
  1. Nader A. Nassif MD
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  2. Danyal H. Nawabi MD
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  3. Kirsten Stoner MEng
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  4. Marcella Elpers BS
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  5. Timothy Wright PhD
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  6. Douglas E. Padgett MD
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Corresponding author

Correspondence to Nader A. Nassif MD.

Additional information

One of the authors (TW) received institutional support from Synthes Spine, West Chester, PA, USA, and Stryker, Mahwah, NJ, USA. One of the authors (DEP) is a consultant for Mako, Ft. Lauderdale, FL, USA, and Stryker. One or more of the authors has a royalty agreement with Mako (DEP) and Mathys, Bettlach, Switzerland (TW). One of the authors (TW) has ownership interest in Exactech, Gainesville, FL, USA.

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.

Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

This work was performed in the Mary and Fred Trump Institute for Implant Analysis (Hospital for Special Surgery, New York, NY, USA).

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigation were conducted in conformity with ethical principle of research, and that informed consent for participation in the study was obtained.

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Nassif, N.A., Nawabi, D.H., Stoner, K. et al. Taper Design Affects Failure of Large-head Metal-on-metal Total Hip Replacements. Clin Orthop Relat Res 472, 564–571 (2014). https://doi.org/10.1007/s11999-013-3115-3

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  • DOI: https://doi.org/10.1007/s11999-013-3115-3

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