AAHKS Symposium: Corrosion at the Head-Neck Junction: Why is this Happening Now?Evaluation of the Painful Dual Taper Modular Neck Stem Total Hip Arthroplasty: Do They All Require Revision?
Section snippets
Factors Associated With Modular Neck Taper Corrosion
Implant, surgical, and patient factors have been identified as likely contributing factors responsible for taper corrosion in dual modular neck stem THA.
Systematic Evaluation
A painful modular dual taper stem neck THA can present with a myriad of symptoms and may be attributable to various intrinsic and extrinsic causes. A systematic evaluation should include focused clinical history, detailed physical examination, laboratory tests, and cross-sectional imaging to identify potential differential diagnoses in a patient with painful dual modular taper THA 36, 37. A consensus systematic risk stratification algorithm from the American Association of Hip and Knee Surgeons
Revision Surgery
Management of a patient with a painful dual taper modular neck stem THA presenting with elevated metal ion levels and evidence of adverse local tissue reactions (pseudotumors) with bone or muscle damage warrants revision surgery. Revision surgery for dual-taper modular neck stem THA necessitates a thoughtful approach to reduce intraoperative complications. Meticulous and careful debridement must be performed to remove the pseudotumor, while protecting neurovascular structures. Removal of the
Histopathology Analysis
Although ALTR has been linked to modular taper junction MACC and elevated metal ion levels, ALTR has also been observed in the absence of high wear or metallosis 30, 31, 32. Current evidence has indicated that the process is complex and multifactorial, with a spectrum of histologic features being noted in periprosthetic tissues of dual-taper modular neck stem THA patients undergoing revision. The histologic features suggest tissue reactions that maybe consistent with either metallic wear and
Summary
Although dual taper modular-neck total hip arthroplasty (THA) design with additional neck-stem modularity has the potential to optimize hip biomechanical parameters, there is increasing concern as a result of the growing numbers of adverse local tissue reactions due to fretting and corrosion at the neck-stem taper junction. There should be a low threshold to conduct a systematic clinical evaluation of patients with dual-taper modular neck stem THA as early recognition and diagnosis will ensure
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Comparison of leg length discrepancy correction after the use of a modular neck stem and its monoblock homologue in total primary hip arthroplasty
2022, Revista Espanola de Cirugia Ortopedica y TraumatologiaIn vitro and in vivo investigations of a-C/a-C:Ti nanomultilayer coated Ti6Al4V alloy as artificial femoral head
2019, Materials Science and Engineering CCitation Excerpt :Researches have shown that wear debris, especially ultra high molecular weight polyethylene (UHMWPE) particles, lead to deleterious biological responses, osteolysis and ultimately component loosening and implant failure [3]. Moreover, the metal ions released from implant, such as nickel (Ni), cobalt (Co) or chromium (Cr), sometimes causing dramatic necrotic and inflammatory changes of periprosthetic tissue [4], increasing the risk of bone resorption [5]. Many studies have been conducted to prolong the longevity of prostheses, the surface modification technique has become a popular method due to its improved performance in implant application [6].
Gross trunnion failure after a metal-on-polyethylene total hip arthroplasty leading to dissociation at the femoral head-trunnion interface
2019, Arthroplasty TodayCitation Excerpt :Some surgeons believe that patients with risk factors for MACC should have scheduled follow-up every 3 years with radiographs to evaluate for early signs of implant failure and screening for serum Co and Cr levels [8]. Some surgeons even advocate that symptomatic patients with positive screening studies should be further evaluated for pseudotumor with metal artifact reduction sequence magnetic resonance imaging and be considered for early revision surgery with femoral head exchange to a ceramic head with titanium sleeve or to a smaller head size while the trunnion is still salvageable [8,9,12]. More importantly, we suggest being thoughtful about minimizing the risk factors listed above when able in high-risk patient populations to reduce the incidence of MACC.
Metal ion release barrier function and biotribological evaluation of a zirconium nitride multilayer coated knee implant under highly demanding activities wear simulation
2018, Journal of BiomechanicsCitation Excerpt :In vitro and in vivo studies have shown that high metal ion concentrations are toxic and known to interfere with biological functions (Catelas et al., 2011; Friesenbichler et al., 2014; Posada et al., 2015; Tower, 2010). Some adverse local tissue reactions (ALTR) against metal debris include delayed hypersensitivity, osteolysis, pseudotumor formation, metallosis and local soft tissue reactions such as inflammation and necrosis (Friesenbichler et al., 2014; Jacobs et al., 2014; Kwon et al., 2016; Kwon, 2016; Mistry et al., 2016). When comparing the effects of Co and Cr ions on macrophages, it has been demonstrated that both induce tumor necrosis factor alpha (TNF-α) release and macrophage mortality, but Co is more toxic than Cr (Catelas et al., 2011) and it activates the toll-like receptor 4 (TLR-4), inducing inflammation similar to that observed during sepsis (Lawrence et al., 2014; Rachmawati et al., 2013).