Risk factors for taper corrosion in total hip arthroplasty

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Research continues towards a better understanding of total hip arthroplasty taper corrosion in modular connections between metal device components. Corrosion has mainly been documented in metal-on-metal joint articulations but a growing number of cases involving metal-on-polyethylene have arisen. Metal debris due to corrosion and wear, loosened by mechanical stress inherent in the design of modular tapers, appears to be the source of clinical symptoms, such as elevated serum metal ions, local tissue reaction, and implant failure. We look at a number of suspected factors that, when combined in vivo, have contributed to the problem.

 

Hip joint replacement is the most common orthopedic joint surgery [1]. In the EU it is the second most common surgical procedure after Caesarean sections [2]. Rates for total hip arthroplasty (THA) are growing around the world and younger patients are undergoing the procedure; the American Academy of Orthopedic Surgeons (AAOS) reported a 123 percent increase between 2000 and 2009 in the 45 to 64 age group. While women are more likely to be recipients of an artificial hip, it has been estimated that more than 2.5 million Americans are living with this implant [3], with a further 300,000 Americans and more than 80,000 people in the UK receiving new hips each year [4].

 

Metal modularity

Considering the frequency with which THA is performed, any tool that can assist surgeons with their tasks in the operating room, whether it be for primary or revision surgery, are usually welcome additions. Introduced in the 1980s and 1990s, modular implants were thought to help surgeons customize biomechanics. Modular implant pieces facilitated an easier achievement of offset, limb length, and anteversion, which is a complex endeavor [5].

The introduction of modular metal-on-metal total hip joint articulations with large heads (MoM THA) was seen as an opportunity and promoted by most device companies, embraced by many surgeons and as a result, a significant number of patients received this combination. Modular MoM THA appeared to be a great solution to stability issues, and an alternative to resurfacing, particularly for revisions due to failed femoral neck fracture [6].

 

Figure 1. An AP x-ray of a pelvis showing a total hip joint replacement. A metal prosthesis is cemented in the top of the right femur and the head of the femur has been replaced by the rounded head of the prosthesis. A white plastic cup is cemented into the acetabulum to complete the two surfaces of the artificial "ball and socket" joint. Source: NIADDK, 9AO4 (Connie Raab); NIH. Public domain.
Read an interview with Michael Morlock PhD, Director of the Biomechanics Institute at the Hamburg University of Technology in Germany. He outlines a timeline of the taper junction corrosion issue and suggests a course of action to address the issue.

It’s been asserted that surgeons only contemplate the strength of a material when choosing a modular junction. But this single consideration neglects a “totality of factors”, such as corrosion resistance, cost, and manufacturing constraints [7]. When it comes to selecting a femoral head, cobalt/chromium (Co/Cr) alloys are low cost and also strong, which are desirable features [8]. Coupled with the advantages of modular design (intraoperative flexibility, simplified procedures, decreased inventory) it is easy to see why modular metal implants are handy in the toolbox.

However, corrosion at the taper junction in modular hip implants is increasingly suspected to contribute to mortality, adverse tissue reaction, such as pseudotumors, and device failure [7, 8, 9, 10], regardless of the type of articulating bearing surface used [11]. One recalled modular head-neck stem implant has had reported failure rates of 86 percent within three to five years [12].

 

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  • Indications of trouble
  • A slow call to action
  • Corrosion through a combination of risk factors
    • Devices
    • Patients
    • Installation
  • A complex problem
  • Interview with Michael Morlock
    • First observations
    • Predominant risk factors
    • Vulnerable patients and products
    • Corrosion issues in other joint replacements
    • Needed changes in surgical practice and implant design
  • References

Part 2 | How to diagnose taper corrosion
 

Read here

Part 3 | Surgical options for addressing taper corrosion

Read here

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Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):

Moussa Hamadouche

Cochin University Hospital
Paris, France

Michael Morlock

Hamburg University of Technology
Hamburg, Germany

Carsten Perka

Charité—University Medicine Berlin
Berlin, Germany

This issue was created by Word+Vision Media Productions, Switzerland

 

References

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