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THA corrosion

Young-Min Kwon, Tsung-Yuan Tsai, William A Leone, Ming Han Lincoln Liow
BACKGROUND: Currently, no serum metal ion threshold exists to identify adverse tissue reactions in total hip arthroplasty (THA) patients with taper corrosion. Our study aims to investigate the sensitivity and specificity of serum metal ions in detecting taper corrosion related pseudotumors in patients with dual taper modular THA. METHODS: A total of 148 patients with dual taper modular THA were investigated: (1) 90 patients with pseudotumors detected with metal artifact reduction sequence-magnetic resonance imaging (MARS-MRI) and (2) 58 patients without pseudotumors on MARS-MRI...
September 28, 2016: Journal of Arthroplasty
Sonika Patel, Carl T Talmo, Sumon Nandi
BACKGROUND: Taper corrosion at the modular junctions of total hip arthroplasty (THA) femoral stems are known to cause locally destructive adverse local tissue reaction (ALTR). However, the implants at risk remain to be fully elucidated. CASE REVIEW: We report the case of a 76-year-old woman with hip pain, abductor weakness, and sciatic nerve symptoms 2 years following metal-on-polyethylene THA. Serum cobalt levels were elevated, while chromium levels were normal...
November 10, 2016: Hip International: the Journal of Clinical and Experimental Research on Hip Pathology and Therapy
Marianne H Gillam, Nicole L Pratt, Maria C S Inacio, Elizabeth E Roughead, Sepehr Shakib, Stephen J Nicholls, Stephen E Graves
Background and purpose - It is unclear whether metal particles and ions produced by mechanical wear and corrosion of hip prostheses with metal-on-metal (MoM) bearings have systemic adverse effects on health. We compared the risk of heart failure in patients with conventional MoM total hip arthroplasty (THA) and in those with metal-on-polyethylene (MoP) THA. Patients and methods - We conducted a retrospective cohort study using data from the Australian Government Department of Veterans' Affairs health claims database on patients who received conventional THA for osteoarthritis between 2004 and 2012...
October 19, 2016: Acta Orthopaedica
Cody C Wyles, Benjamin A McArthur, Eric R Wagner, Matthew T Houdek, Jose H Jimenez-Almonte, Robert T Trousdale
Trunnionosis and taper corrosion have recently emerged as problems in total hip arthroplasty (THA). No longer restricted to metal-on-metal bearings, these phenomena now affect an increasing number of metal-on-polyethylene THAs and are exacerbated by modularity. Resulting increases in metal toxicity and patient morbidity, and the added costs of toxicity surveillance and revision surgery, will place a substantial economic burden on many health systems. Although they are more expensive than cobalt-chrome heads, ceramic femoral heads make metal toxicity a nonissue...
September 2016: American Journal of Orthopedics
Lisa Renner, Tom Schmidt-Braekling, Martin Faschingbauer, Friedrich Boettner
INTRODUCTION: Serum metal ions are part of the regular follow-up routine of patients with metal-on-metal total hip arthroplasties (MoM-THA). Increased cobalt levels have been suggested to indicate implant failure and corrosion. QUESTIONS: (1) Is there a correlation between the size of the osteolysis measured on a CT scan and metal ion levels? (2) Can metal ion levels predict the presence of osteolysis in MoM-THA? (3) Are cobalt and chromium serum levels or the cobalt-chromium-ratio diagnostic for osteolysis? MATERIALS AND METHODS: CT scans of patients (n = 75) with a unilateral MoM-THA (Birmingham Hip System, Smith & Nephew, TN, USA) implanted by a single surgeon were reviewed to determine the presence of osteolysis...
September 15, 2016: Archives of Orthopaedic and Trauma Surgery
Joshua J Jacobs
While mechanically-assisted crevice corrosion (MACC) at the head/neck junction of modular total hip arthroplasty (THA) femoral components was first described over two decades ago, it is only within the last few years that investigators have observed that adverse local tissue reactions (ALTRs) associated with MACC are an increasingly prevalent mode of failure of contemporary THAs. As yet, the incidence, etiology and pathogenesis of MACC-associated ALTR are not well understood. In this review, possible implant-, patient-, and surgeon-related factors are considered in the context of a small but growing body of evidence from laboratory simulations, implant and tissue retrieval studies and clinical case series...
July 2016: Journal of Arthroplasty
A A Sassoon, R L Barrack
The use of large-diameter metal-on-metal (MoM) components in total hip arthroplasty (THA) is associated with an increased risk of early failure due to adverse local tissue reaction to metal debris (ARMD) in response to the release of metal ions from the bearing couple and/or head-neck taper corrosion. The aim of this paper was to present a review of the incidence and natural history of ARMD and the forms of treatment, with a focus on the need for and extent of resection or debulking of the pseudotumour. An illustrative case report is presented of a patient with an intra-pelvic pseudotumour associated with a large diameter MoM THA, which was treated successfully with revision of the bearing surface to a dual mobility couple and retention of the well-fixed acetabular and femoral components...
June 2016: Bone & Joint Journal
Rami Madanat, Ola Rolfson, Gabrielle S Donahue, Daniel K Hussey, Hollis G Potter, Robert Wallace, Orhun K Muratoglu, Henrik Malchau
BACKGROUND: Medial calcar erosion is considered a late finding in patients with severe adverse local tissue reactions (ALTRs) after total hip arthroplasty (THA) with dual modular neck stems. Although calcar erosion has been associated with dual modular neck stems, one would expect similar findings in standard stems owing to analogous corrosion at the taper junction. The aim of this study was to evaluate whether medial calcar erosion is also associated with ALTR in patients with standard stems in metal-on-metal (MoM) THA...
April 13, 2016: Journal of Arthroplasty
Young-Min Kwon
Although dual taper modular-neck total hip arthroplasty (THA) design with additional neck-stem modularity has the potential to optimize hip biomechanical parameters by facilitating adjustments of leg length, femoral neck version and offset, there is increasing concern regarding this stem design as a result of the growing numbers of adverse local tissue reactions due to fretting and corrosion at the neck-stem taper junction. Implant factors such as taper cone angle, taper surface roughness, taper contact area, modular neck taper metallurgy, and femoral head size play important roles in influencing extent of taper corrosion...
July 2016: Journal of Arthroplasty
Christopher Del Balso, Matthew G Teeter, Sok Chuen Tan, James L Howard, Brent A Lanting
BACKGROUND: Wear and tribocorrosion at the modular head-neck taper interface may be a cause of failure in metal-on-polyethylene total hip arthroplasty (THA). The present investigation endeavored to elucidate the effect of femoral head diameter on fretting and corrosion in retrieved head-neck tapers. METHODS: A retrieval analysis of THA prostheses in vivo for a minimum of 1 year was performed. Twenty-three femoral heads of 32-mm diameter were matched with 28-mm heads based on time in vivo and head length (-3 mm to +8 mm)...
October 2016: Journal of Arthroplasty
Lisa Renner, Martin Faschingbauer, Tom Schmidt-Braekling, Friedrich Boettner
INTRODUCTION: Metal-on-metal (MoM) bearings are known to release metal ions secondary to wear and corrosion. This may cause local reactions (adverse soft tissue reactions and osteolysis) and systemic effects. Little is known about the exact pattern and the differences between large head MoM total hip replacements (THA) and resurfacings (HR). QUESTIONS: (1) Is there a difference in metal ion concentrations between HR and MoM-THR using the same bearing design (Birmingham Hip Resurfacing System, Smith & Nephew, Inc...
May 2016: Archives of Orthopaedic and Trauma Surgery
Benjamin F Ricciardi, Allina A Nocon, Seth A Jerabek, Gabrielle Wilner, Elianna Kaplowitz, Steven R Goldring, P Edward Purdue, Giorgio Perino
BACKGROUND: Adverse local tissue reaction (ALTR), characterized by a heterogeneous cellular inflammatory infiltrate and the presence of corrosion products in the periprosthetic soft tissues, has been recognized as a mechanism of failure in total hip replacement (THA). Different histological subtypes may have unique needs for longitudinal clinical follow-up and complication rates after revision arthroplasty. The purpose of this study was to describe the histological patterns observed in the periprosthetic tissue of failed THA in three different implant classes due to ALTR and their association with clinical features of implant failure...
2016: BMC Clinical Pathology
Ming Han Lincoln Liow, Kenneth L Urish, Frederic I Preffer, Gunnlaugur P Nielson, Young-Min Kwon
BACKGROUND: The underlying biological mechanism in the formation of adverse local tissue reaction in taper corrosion of total hip arthroplasty (THA) remains unknown. This study evaluated whether there was a dose-dependent relationship between metal ion levels, intraoperative tissue damage and ALVAL (aseptic lymphocyte-dominated vasculitis-associated lesion) scores in dual taper THA patients who underwent revisions for taper corrosion. METHODS: We performed a retrospective review of 31 dual taper THA patients who underwent revision surgery from May 2013 to October 2013...
August 2016: Journal of Arthroplasty
N J Lash, M R Whitehouse, N V Greidanus, D S Garbuz, B A Masri, C P Duncan
AIMS: We present a case series of ten metal-on-polyethylene total hip arthroplasties (MoP THAs) with delayed dislocation associated with unrecognised adverse local tissue reaction due to corrosion at the trunnion and pseudotumour formation. METHODS: The diagnosis was not suspected in nine of the ten patients (six female/four male; mean age 66 years), despite treatment in a specialist unit (mean time from index surgery to revision was 58 months, 36 to 84). It was identified at revision surgery and subsequently confirmed by histological examination of resected tissue...
February 2016: Bone & Joint Journal
Harry S Hothi, Reshid Berber, Robert K Whittaker, Gordon W Blunn, John A Skinner, Alister J Hart
BACKGROUND: The size of the clinical impact of corrosion of the taper junction of metal-on-metal total hip arthroplasties (MOM-THAs) is unclear. Examination of a large number of retrieved MOM resurfacings and total hip arthroplasties can help us understand the role of taper corrosion in metal ion release. METHODS: We graded the severity of corrosion at the taper junction of 395 MOM-THAs and compared the prerevision whole blood metal ion levels of these hips with 529 failed MOM hip resurfacings...
May 2016: Journal of Arthroplasty
Laura Matsen Ko, Jacob J Coleman, Venessa Stas, Paul J Duwelius
Corrosion of modular components at the femoral neck remains a complication of total hip arthroplasty (THA). The authors have found the iliopsoas sign (pain on resisted flexion of the hip) to be suggestive of femoral component corrosion. These cases represented 8 of 120 revision hip arthroplasties (7%) performed at the authors' institution. After the revisions, all iliopsoas tendonitis symptoms resolved. Based on the authors' experience and the recent literature, they recommend that the iliopsoas sign or presentation of a sterile iliopsoas abscess in a previously well-functioning THA be concern for corrosion of the femoral component of the total hip...
October 2015: Orthopedic Clinics of North America
Laura J Matsen Ko, Kimberley E Pollag, Joanne Y Yoo, Peter F Sharkey
Dual mobility acetabular components can reduce the incidence of total hip arthroplasty (THA) instability. Modular dual mobility (MDM) components facilitate acetabular component implantation. However, corrosion can occur at modular junctions. Serum cobalt and chromium levels and Oxford scores were obtained at minimum two year follow-up for 100 consecutive patients who had THA with MDM components. Average Oxford score was 43 (range 13-48). Average serum cobalt and chromium values were 0.7 mcg/L (range, 0.0 to 7...
January 2016: Journal of Arthroplasty
M R Whitehouse, M Endo, S Zachara, T O Nielsen, N V Greidanus, B A Masri, D S Garbuz, C P Duncan
Adverse reaction to wear and corrosion debris is a cause for concern in total hip arthroplasty (THA). Modular junctions are a potential source of such wear products and are associated with secondary pseudotumour formation. We present a consecutive series of 17 patients treated at our unit for this complication following metal-on-highly cross-linked polyethylene (MoP) THA. We emphasise the risk of misdiagnosis as infection, and present the aggregate laboratory results and pathological findings in this series...
August 2015: Bone & Joint Journal
C Anderson Engh, Supatra Sritulanondha, Abigail Korczak, Terrence David Whalen, Douglas D R Naudie, Richard W McCalden, Steven J MacDonald
BACKGROUND: Hard-on-hard bearings for total hip arthroplasty continue to warrant analysis even though crosslinked polyethylene is performing very well. Ceramic-on-metal (CoM) has low in vitro wear and did well in an early clinical trial. We report on a prospective, randomized, multicenter investigational device trial comparing CoM with metal-on-metal (MoM). QUESTIONS/PURPOSES: (1) Is there a difference in the number or type of revisions comparing CoM with MoM? (2) Are cobalt and chromium metal levels different for CoM and MoM THA? METHODS: Between August 2005 and October 2006, of 1015 patients screened, 390 patients were enrolled at 11 centers and randomized to 194 CoM and 196 MoM bearings...
February 2016: Clinical Orthopaedics and related Research
C Del Balso, M G Teeter, S C Tan, B A Lanting, J L Howard
Tribocorrosion at the head-neck taper interface - so-called 'taperosis' - may be a source of metal ions and particulate debris in metal-on-polyethylene total hip arthroplasty (THA). We examined the effect of femoral head length on fretting and corrosion in retrieved head-neck tapers in vivo for a minimum of two years (mean 8.7 years; 2.6 to 15.9). A total of 56 femoral heads ranging from 28 mm to 3 mm to 28 mm + 8 mm, and 17 femoral stems featuring a single taper design were included in the study. Fretting and corrosion were scored in three horizontally oriented concentric zones of each taper by stereomicroscopy...
July 2015: Bone & Joint Journal
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