Evidence Based Recommendations for Reducing Head-Neck Taper Connection Fretting Corrosion in Hip Replacement Prostheses

2017 ◽  
Vol 27 (6) ◽  
pp. 523-531 ◽  
Author(s):  
Christian M. Wight ◽  
Brent Lanting ◽  
Emil H. Schemitsch
Keyword(s):  
Flexural Rigidity ◽  
Prosthetic Design ◽  
Fretting Corrosion ◽  
Strict Adherence ◽  
Hip Prostheses ◽  
Relative Contribution ◽  
Metal On Metal ◽  
Femoral Heads ◽  
Connection Design ◽  
Head Neck

Introduction This systematic review seeks to summarise the published studies investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion at the head-neck taper connection, and provide clinical recommendations to reduce its occurrence. Methods PubMed, MEDLINE and EMBASE electronic databases were searched using the terms taper, trunnion, cone and head-neck junction. Articles investigating prosthetic design, manufacture and surgical technique's effect on fretting corrosion were retrieved, reviewed and graded according to OCEBM levels of evidence and grades of recommendation. Results The initial search yielded 1,224 unique articles, and 91 were included in the analysis. Conclusions There is fair evidence to recommend against the use of high offset femoral heads, larger diameter femoral heads, and to pay particular consideration to fretting corrosion's progression with time and risk with heavier or more active patients. Particular to metal-on-metal hip prostheses, there is fair evidence to recommend positioning the acetabular component to minimise edge loading. Particular to metal-on-polyethylene hip prostheses, there is fair evidence to recommend the use of ceramic femoral heads, against use of cast cobalt alloy femoral heads, and against use of low flexural rigidity femoral stems. Evidence related to taper connection design is largely conflicting or inconclusive. Head-neck taper connection fretting corrosion is a multifactorial problem. Strict adherence to the guidelines presented herein does not eliminate the risk. Prosthesis selection is critical, and well-controlled studies to identify each design parameter's relative contribution to head-neck taper connection fretting corrosion are required.

scholarly journals A Case of a C-Stem Fracture at the Head-Neck Junction and a Review of the Literature

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
David Morley ◽  
Ian Starks ◽  
Justin Lim
Keyword(s):  
Fatigue Failure ◽  
Review Of The Literature ◽  
First Case ◽  
Metal On Metal ◽  
Femoral Heads ◽  
Stem Fracture ◽  
Active Patients ◽  
Large Femoral Heads ◽  
Head Neck ◽  
Neck Junction

We report the first case of a fracture of the standard C-stem in combination with a large metal-on-metal articulation. This occurred at the head-neck junction. Analysis of the fractured stem showed evidence of fatigue failure with possible corrosion. The use of large femoral heads with neck adaptors and narrow tapers should be used with caution, especially in heavy, active patients.

An in vitro study of the reduction in wear of metal-on-metal hip prostheses using surface-engineered femoral heads

2002 ◽  
Vol 216 (4) ◽  
pp. 219-230 ◽  
Author(s):  
J Fisher ◽  
X Q Hu ◽  
J L Tipper ◽  
T D Stewart ◽  
S Williams ◽  
...  
Keyword(s):  
Metal Ion ◽  
Ion Concentration ◽  
Chromium Alloy ◽  
Wear Particles ◽  
Cobalt Chromium ◽  
Hip Prostheses ◽  
Metal On Metal ◽  
Metal Ion Release ◽  
Femoral Heads ◽  
Cobalt Chromium Alloy

Although the wear of existing metal-on-metal (MOM) hip prostheses (1 mm3/106 cycles) is much lower than the more widely used polyethylene-on-metal bearings, there are concerns about the toxicity of metal wear particles and elevated metal ion levels, both locally and systemically, in the human body. The aim of this study was to investigate the possibility of reducing the volume of wear, the concentration of metal debris and the level of metal ion release through using surfaceengineered femoral heads. Three thick (8-12 μm) coatings (TiN, CrN and CrCN) and one thin (2 μm) coating (diamond-like carbon, DLC), were evaluated on the femoral heads when articulating against high carbon content cobalt-chromium alloy acetabular inserts (HC CoCrMo) and compared with a clinically used MOM cobalt-chromium alloy bearing couple using a physiological anatomical hip joint simulator (Leeds Mark II). This study showed that CrN, CrCN and DLC coatings produced substantially lower wear volumes for both the coated femoral heads and the HC CoCrMo inserts. The TiN coating itself had little wear, but it caused relatively high wear of the HC CoCrMo inserts compared with the other coatings. The majority of the wear debris for all half-coated couples comprised small, 30 nm or less, CoCrMo metal particles. The Co, Cr and Mo ion concentrations released from the bearing couples of CrN-, CrCN- and DLC-coated heads articulating against HC CoCrMo inserts were at least 7 times lower than those released from the clinical MOM prostheses. These surface-engineered femoral heads articulating on HC CoCrMo acetabular inserts produced significantly lower wear volumes and rates, and hence lower volumetric concentrations of wear particles, compared with the clinical MOM prosthesis. The substantially lower ion concentration released by these surface-engineered components provides important evidence to support the clinical application of this technology.

Imaging of Metal-on-Metal Hip Prostheses

2011 ◽  
Vol 197 (3) ◽  
pp. 556-557 ◽  
Author(s):  
Matthew W. Squire
Keyword(s):  
Hip Prostheses ◽  
Metal On Metal

Improving Tribological Characteristics of Hip Prostheses Using Biocompatible Nanocoatings

2013 ◽  
Vol 741 ◽  
pp. 67-72 ◽  
Author(s):  
Gheorghe I. Gheorghe ◽  
Liliana Laura Badita
Keyword(s):  
Hip Prosthesis ◽  
Protective Coatings ◽  
Scratch Resistance ◽  
Hip Prostheses ◽  
Force Microscopy ◽  
Tin Coatings ◽  
Femoral Heads ◽  
Before And After ◽  
Tin Thin Films ◽  
Steel Substrates

Total hip prosthesis (THP) is the most success of the 20th century in orthopaedic biomedical engineering. However due to difficult conditions within the human body its durability is generally limited to 15-16 years. THP is a bio-tribosystem, on which many mechanical, thermal, chemical and biological factors act. This paper presents the results of an analysis regarding the topography and tribological parameters of femoral heads structures before and after TiN coating. We report on the synthesis of TiN thin films on steel substrates by pulsed laser deposition (PLD) method for improving the mechanical characteristics of the structures. Adhesion resistance of the coating on the sub-layer was evaluated by scratching tests accompanied by Optical Microscopy (OM), Atomic Force Microscopy (AFM) and Scanning Electron Microscopy (SEM). As a principal result, this work points out that TiN protective coatings deposited by PLD technique with the maximum number of pulses can represent an alternative technology to ensure adhesion and scratch resistance of TiN coatings on femoral heads.

A 5-Year Survival Analysis of 160 Biomet Magnum M2 metal-on-Metal Total Hip Prostheses

2015 ◽  
Vol 26 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Maarten C. Koper ◽  
Nina M.C. Mathijssen ◽  
Stephan B.W. Vehmeijer
Keyword(s):  
Survival Analysis ◽  
Hip Prostheses ◽  
Total Hip ◽  
Metal On Metal ◽  
Total Hip Prostheses

Femoral head material loss at the head-neck junction in total hip arthroplasty: the effect of head size, stem material and stem offset

2018 ◽  
Vol 29 (6) ◽  
pp. 647-651 ◽  
Author(s):  
Giuseppe Valente ◽  
Brent Lanting ◽  
Steven MacDonald ◽  
Matthew G Teeter ◽  
Douglas Van Citters ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Head Size ◽  
Material Loss ◽  
Total Hip ◽  
Femoral Heads ◽  
Measuring Machine ◽  
Head Neck ◽  
Neck Junction

Introduction:Material loss at the head-neck junction in total hip arthroplasty may cause adverse clinical symptoms and implant failure. The purpose of this study was to quantitatively examine the effects of head size, stem material and stem offset on material loss of the head-neck taper interface of a single trunnion design in retrieval implants of metal on polyethylene bearing surfaces.Methods:A retrieval study was performed to identify all 28-mm and 32-mm femoral heads from a single implant/taper design implanted for >2 years. This included n = 56 of the 28-mm heads and n = 23 of the 32-mm heads. The 28-mm femoral heads were matched to 32-mm femoral heads based on time in vivo and head length. A coordinate measuring machine was used to determine maximum linear corrosion depth (MLD). Differences in MLD for head diameter, stem material, and stem offset were determined.Results:There were no differences between groups for age, gender, BMI, or implantation time. There was no difference in MLD between 28 mm and 32 mm matched paired head diameters ( p = 0.59). There was also no difference in MLD between titanium or cobalt-chromium stems ( p = 0.79), and regular or high-offset stems ( p = 0.95).Conclusion:There is no statistical difference in femoral head MLD at the head-neck junction in THA between 28-mm and 32-mm matched paired femoral heads, similar or mixed alloy coupled femoral head stem constructs, and regular or high offset stems.

Metal-on-metal hip prostheses: where are we now?

BMJ ◽  
2012 ◽  
Vol 345 (nov16 1) ◽  
pp. e7792-e7792 ◽  
Author(s):  
J. M. Wilkinson
Keyword(s):  
Hip Prostheses ◽  
Metal On Metal
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