Does increased diameter of metal femoral head associated with highly cross-linked polyethylene augment stress on the femoral stem and cortical hypertrophy?

2021 ◽  
Author(s):  
Seiya Ishii ◽  
Yasuhiro Homma ◽  
Tomonori Baba ◽  
Yuichi Shirogane ◽  
Kazuo Kaneko ◽  
...  
Keyword(s):  
Femoral Head ◽  
Femoral Stem ◽  
Cortical Hypertrophy

scholarly journals Distal Femoral Cortical Hypertrophy after Hip Arthroplasty Using a Cementless Double-Tapered Femoral Stem

2016 ◽  
Vol 24 (3) ◽  
pp. 317-322 ◽  
Author(s):  
Yoon Je Cho ◽  
Young Soo Chun ◽  
Kee Hyung Rhyu ◽  
Jong Hun Baek ◽  
Hu Liang
Keyword(s):  
Clinical Outcome ◽  
Hip Arthroplasty ◽  
Stress Shielding ◽  
Femoral Stem ◽  
Visual Analogue Score ◽  
Thigh Pain ◽  
Harris Hip Score ◽  
Cortical Hypertrophy ◽  
Flare Index ◽  
The Mean

Purpose To review 437 hips in 404 patients who underwent total hip arthroplasty (THA) or hemiarthroplasty using the Accolade TMZF stem to determine the incidence and risk factors of distal femoral cortical hypertrophy (DFCH). Methods Records of 437 hips in 169 men and 235 women aged 26 to 100 (mean, 65.7) years who underwent THA (n=293) or hemiarthroplasty (n=144) using the Accolade TMZF femoral stem by 2 senior surgeons and were followed up for a mean of 54.7 months were reviewed. Clinical outcome was assessed using the modified Harris Hip Score and visual analogue score for pain. Proximal femoral geometry and canal flare index were assessed on preoperative radiographs, and DFCH, stem position, subsidence, loosening, and stress shielding were assessed on postoperative radiographs according to the Gruen zone. Results Of 437 hips, 27 (6.2%) developed DFCH and 410 did not. Hips with DFCH had a higher incidence of thigh pain (18.5% vs. 2.2%, p<0.001) and earlier onset of thigh pain (12.3 vs. 20.8 months, p=0.015), compared with those without. Nonetheless, all femoral stems were well-fixed, and no osteolysis or loosening was detected. The 2 groups achieved comparable clinical outcome in terms of Harris Hip Score and pain. The mean canal flare index was higher in hips with than without DFCH (3.706 vs. 3.294, p=0.002). The mean vertical subsidence of the femoral stem was lower in hips with than without DFCH (1.5 vs. 3.4 mm p<0.001). Subsidence negatively correlated with the canal flare index (correlation coefficient= −0.110, p=0.022). The incidence of the DFCH increased with each unit of increment in canal flare index (odds ratio [OR]=1.828, p=0.043) and each year younger in age (OR=0.968, p=0.015). Conclusion The incidence of DFCH in hips with the Accolade TMZF stem was 6.2%. Patients with a higher canal flare index and younger age had a higher incidence of DFCH. Nonetheless, DFCH did not affect clinical outcome or femoral stem stability.

scholarly journals Mid-Term Outcome of Total Hip Arthroplasty Using a Short Stem

2016 ◽  
Vol 24 (3) ◽  
pp. 323-327 ◽  
Author(s):  
Rajesh Malhotra ◽  
Vijay Kumar
Keyword(s):  
Total Hip Arthroplasty ◽  
Heterotopic Ossification ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Harris Hip Score ◽  
Term Outcome ◽  
Cortical Hypertrophy ◽  
Short Femoral Stem ◽  
The Mean ◽  
Pedestal Formation

Purpose To review the outcome of total hip arthroplasty (THA) using a short femoral stem in 33 hips. Methods Records of 33 hips in 20 men and 10 women aged 25 to 40 (mean, 30) years who underwent cementless THA using a short femoral stem by a single senior surgeon were reviewed. The diagnosis included avascular necrosis (n=9), ankylosing spondylitis (n=12), rheumatoid arthritis (n=7), post-traumatic arthritis (n=4), and Hurler syndrome (n=1). Clinical outcome was assessed using the Harris Hip Score. Radiological outcome was assessed according to a modified Gruen zoning system. Stem positioning (neutral, varus, valgus) and bone contact were evaluated, as were fixation and early host response as well as subsidence and changes in the calcar region (zone 5). Trabecular response (trabecular attachment), spot welds, cortical hypertrophy, and pedestal formation were determined. Heterotopic ossification was graded by the Brooker classification. Results The mean follow-up period was 6.5 years. The mean Harris Hip Score improved from 40 to 90. All hips achieved immediate postoperative stability. No patient had thigh pain. Four hips had varus placement (5°–7°) of the stem; all were asymptomatic and remained stable without any migration. Evidence of proximal load transfer (endosteal spot welds) between the endosteum and the stem in zones 2 and/or 4 was noted in 12 hips on both sides and in 8 hips on the lateral side only. At one year, all stems showed evidence of osseointegration. None had subsidence or progressive varus migration. There was no radiolucent line or osteolysis around the stem, pedestal formation or buttressing at the prosthesis tip, or cortical hypertrophy. One patient had grade I heterotopic ossification that was not clinically significant. One patient had a 1.5 cm leg lengthening. One patient had a discharging sinus, a loosened acetabular component, and intrapelvic migration at 2 years and underwent implant removal and debridement. One patient developed a crack in the proximal femur even with the smallest stem. The stem was fixed with cerclage wiring and remained stable with no migration. Conclusion A short femoral stem design that transfers load proximally through a prominent lateral flare achieved good short-term outcome in younger patients. Nonetheless, the ease of removal and preservation of bone at the time of revision should guide the choice of the design of the short stem.

scholarly journals Spontaneous Early Intraprosthetic Dislocation of 22 mm Skirted Femoral Head in Dual Mobility Hip Prosthesis: A Case Report

2021 ◽  
Vol 11 (5) ◽  
Author(s):  
Gur Aziz Singh Sidhu ◽  
Amit Kotecha ◽  
Sanjay Mulay ◽  
Neil Ashwood
Keyword(s):  
Case Report ◽  
Femoral Head ◽  
Revision Surgery ◽  
Hip Prosthesis ◽  
Weight Bearing ◽  
Femoral Stem ◽  
Acetabular Cup ◽  
Dual Mobility ◽  
Metal Head ◽  
Intraprosthetic Dislocation

Introduction: There is a trend for increasing use of dual mobility hip designs for both primary and revision hip arthroplasty settings. It provides dual articular surfaces along with increased jump distance to increase the stability of construct. However, this design has some unique complications of its own which surgeons should be aware of especially intraprosthetic dislocation (IPD). Case Report: A 76-year-old lady presented to clinic with painful hip hemiarthroplasty after fracture neck of femur. She underwent revision surgery with dual mobility uncemented acetabular cup and femoral stem was retained as it was well fixed. She was mobilizing well and around 5 weeks post her surgery, developed pain in hip region and difficulty in weight-bearing. Radiographs showed eccentric position of femoral neck in the socket. A diagnosis of IPD was established and revision surgery was planned. Intraoperatively, metal head had dislocated from the polyethylene head and both components were resting in the acetabular socket. No macroscopic erosion of acetabulum was noticed. The polyethylene component and femoral head were retrieved. With previous failed dual mobility, decision was made to achieve stability with larger head size and lipped liner posteriorly. Conclusion: IPD is a rare occurrence and unique complication to dual mobility implants. This report highlights that patients can have IPD without fall or trauma. Keywords: Intraprosthetic dislocation, dual mobility cup, dislocation, total hip replacement.

A Finite Element Investigation into the Effects of Head Size and Trunnion Design on the Micromotion at the Head-Neck Interface in THR

2014 ◽  
Vol 553 ◽  
pp. 287-292
Author(s):  
W. Theodore ◽  
J. Pierrepont ◽  
Q. Li ◽  
B. Miles
Keyword(s):  
Finite Element ◽  
Femoral Head ◽  
Case Reports ◽  
Three Dimensional ◽  
Femoral Stem ◽  
Element Model ◽  
Head Size ◽  
Metal Head ◽  
The Stability ◽  
Head Neck

The modularity of femoral head and femoral stem provides many benefits to surgeons. However, case-reports have shown failure in large head Metal-on-Metal hip replacement due to trunnionosis. The exact causes of trunnionosis are not yet identified but the additional interface at the modular joint seems to be a contributing factor. In this study, a three dimensional non-linear finite element model was created to analyse the effects of head size and trunnion design on the micromotion at the head-neck interface. Four different metal head sizes and two trunnions designs and materials were used in the model. The femoral heads were assembled onto the trunnions with 7kN axial force and one cycle of gait load was applied to the head after assembly. The study showed that the micromotion was substantially increased in femoral head larger than 36mm. Trunnions material has greater effect on micromotion than trunnion design, particularly with the larger head sizes. The stability at the modular junction is important. Our findings suggest that there is a limit of assembly force to maintain enough stability on the joint; beyond this limit; the maximum micromotion will not be affected.

scholarly journals Long Term Survivorship of a Severely Notched Femoral Stem after Replacing the Fractured Ceramic head with a Cobalt-Chromium Head

2016 ◽  
Vol 10 (1) ◽  
pp. 779-784 ◽  
Author(s):  
Andreas Panagopoulos ◽  
Irini Tatani ◽  
Panagiotis Megas
Keyword(s):  
Femoral Head ◽  
Femoral Stem ◽  
Normal Activity ◽  
X Rays ◽  
Ceramic Head ◽  
Cobalt Chromium ◽  
Ceramic Femoral Head ◽  
Walking Aids

Background: Although ceramic head fracture occurs infrequently today, in the event of a fracture, the resulting revision surgery can prove very challenging, since the ceramic particles lodge into the surrounding soft tissue and can cause rapid implant failure Case Presentation: A case of long term survivorship of a severed notched femoral stem after replacing the fractured femoral head with a cobalt-chromium one is reported in a 40-year old woman with hip dysplasia who underwent an uncomplicated total hip arthroplasty. The incident of ceramic femoral head fracture occurred 14 months postoperatively without reporting any significant trauma. Intraoperative findings at revision were a multifragmented femoral head and a damaged polyethylene insert along with diffuse metallosis and excessive wear of the cone of the stem. Both the stem and the acetabular component were stable. After removal of ceramic fragments, metallotic tissue excision and careful lavage of the joint, the inlay was replaced by a similar one and a cobalt-chromium femoral head was placed to the existing notched taper of the firmly incorporated stem. At the 13th year follow up examination, the patient had no pain, used no walking aids, and had normal activity with no signs of wearing or loosening in the plain x-rays. Conclusion: Despite current recommendations of using ceramic femoral heads in cases of fracture or to revise the severely damaged stems we were able to provide a long term survivorship up to 13 years postoperatively of a cobalt-chromium femoral head applied to a severe damaged stem.

scholarly journals Horror of three synergistic factors in THA: high mechanical stress, dissimilar metals, low elasticity stem: a case report

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Seiya Ishii ◽  
Yasuhiro Homma ◽  
Takehisa Matsukawa ◽  
Tomonori Baba ◽  
Ayano Kubota ◽  
...  
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Large Diameter ◽  
Femoral Stem ◽  
Frictional Torque ◽  
Cobalt Chromium ◽  
Total Hip ◽  
Metal Head

Abstract Background A large-diameter femoral head is effective in preventing dislocation after total hip arthroplasty. However, although rare, catastrophic stem tribocorrosion may occur at the head-stem junction. Case presentation A 70-year-old woman underwent revision surgery 7.5 years after total hip arthroplasty because of catastrophic stem corrosion with dissociation of the metal head (cobalt/chromium) and stem (TiMo12Zr6Fe2). Abnormal levels of cobalt were found in the intra-articular fluid, capsule, hip muscle, and blood. Revision surgery was performed via the direct anterior approach. The well-fixed femoral stem was explanted, and a cemented stainless stem with stainless head was implanted. Three months after the revision surgery, the cobalt concentration in the blood had decreased to normal. Conclusions Stem dissociation in the present case might have been caused by synergistic combination of a 36-mm-diameter femoral head and long neck length offset with high frictional torque, a cobalt-chromium head with a high risk of galvanic corrosion, and a TMZF (TiMo12Zr6Fe2) alloy stem with a low Young’s modulus of elasticity. The combination of these factors must be avoided.

scholarly journals EVALUATION OF THE RESULTS OF CEMENTLESS TOTAL HIP ARTHROPLASTY IN PATIENTS WITH STAGES IV, V AND VI OSTEONECROSIS OF THE FEMORAL HEAD

2020 ◽  
Vol 62 (1) ◽  
Author(s):  
Đắc Việt Mai ◽  
Thu Thủy Nguyễn
Keyword(s):  
Femoral Head ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Bone Ingrowth ◽  
Femoral Stem ◽  
Stage Iv ◽  
Harris Hip Score ◽  
Total Hip ◽  
The Mean

This study aimed to report the outcome of total hip arthroplasty (THA) with an extensive hydroxyapatite (HA) coating for the fixation of a tapered femoral stem (Corail) in patients aged 60 or younger than sixty years with stage IV, V và VI osteonecrosis of femoral head. Subject and method: Descriptive prospective research of ninety osteonecrotic hips in ninety patients were available for clinical and radiographic analyses at minimum follow-up of 5 years. Results and Conclusion: The mean Harris hip score improved from 43.74 ± 9,25points preoperatively to 96.67 ± 3.82points at final follow-up. Seventy-four (100%) hips demonstrated stable bone ingrowth. No hips showed acetabular or femoral osteolysis radiolucency and loosening, or required revision for aseptic loosening. We believe that cementless THA with a Corail stem is a promising procedure for patients with osteonecrosis of the femoral head.

Modularity of total hip prosthesis and its tribological implications

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Liliana-Laura Badita ◽  
Virgil Florescu ◽  
Constantin Tiganesteanu ◽  
Lucian Capitanu
Keyword(s):  
Femoral Head ◽  
Hip Prosthesis ◽  
Femoral Stem ◽  
Fretting Wear ◽  
Fretting Corrosion ◽  
Content Type ◽  
Hip Prostheses ◽  
Total Hip ◽  
Starting Point ◽  
Modular Prostheses

Purpose The study aims to analyze the fretting phenomenon, manifested at the taper junctions of modular total hip prostheses (THP). Modularity of prostheses implies the micro-movement occurrence. Fractures can arise as a result of the fretting cracking of the prostheses components, affecting durability of modular THPs. Fretting corrosion is associated with the decrease in the clinical acceptance of hip modular implants. Design/methodology/approach Starting from the fretting phenomenon influence on modularity, monoblock THPs and prostheses with modular femoral head recovered from some review surgeries were investigated. Modular prostheses have a taper junction femoral head – femoral stem neck. Investigation consisted in the analysis of fretting wear and fretting corrosion, of the femoral heads’ taper and of the femoral stems’ trunnions. Findings The main result was that the micro-movement that provokes the fretting of the femoral head-femoral stem taper junction analyzed does not have the same direction. It is manifesting in the direction of the axis of the femoral head taper, around this axis or as a composed movement. The authors suspect that this is due to the different design of the taper. In this way, the inclination of the stem’s trunnion into the head hole has a different angular misalignment and may cause greater damages of the taper. Originality/value This result can be a starting point from the improvement of the future taper junctions design that will improve the quality, durability and modularity of THPs.

Catastrophic failure of the Accolade I hip arthroplasty stem: a retrieval analysis study

2020 ◽  
Vol 30 (4) ◽  
pp. 481-487
Author(s):  
Christopher W Wylde ◽  
Elizabeth Jenkins ◽  
Moreica Pabbruwe ◽  
Thomas Bucher
Keyword(s):  
Femoral Head ◽  
Femoral Stem ◽  
Time Frame ◽  
Great Success ◽  
Retrieval Analysis ◽  
Wear Pattern ◽  
Bird Beak ◽  
Neck Fracture ◽  
Combination Of Material

Purpose: Modular Morse tapered femoral arthroplasty stems have been used for many years with great success and minimal complications. 1 stem, the Accolade by Stryker is noted to have increased failure when used in combination with LFIT V40 CoCr or the MITCH CoCr femoral heads. The failure has been in the form of corrosion, metallosis, fretting and trunnion fracture. This paper explores 10 cases with trunnion failure. Methods: A retrospective retrieval analysis of ten femoral stems retrieved at four different centres across Western Australia over a 3-year time frame. Inclusion criteria for this analysis included the use of Accolade 1 TMZF femoral stem plus either a MITCH or LFIT modular head. Results: 10 Accolade I (Stryker) stems were retrieved as part of the analysis, 6 with the LFIT V40 36-mm femoral head and 4 with a MITCH TRH femoral head. Average in situ time was 8.9 years. The hips were revised for either trunnion dislocation (6 cases) or trunnion fracture (4 cases). A characteristic destructive wear pattern of the femoral taper (trunnion) a “bird beak” appearance was present in all stems. This wear pattern created excessive movement and loosening resulting in a trunnion/head dislocation or brittle fracture of the trunnion. Conclusions: Catastrophic femoral neck fracture was likely due to a combination of material composition mismatch and mechanically assisted fretting corrosion at the head-neck junction leading to gross metallosis and failure. We suggest a recall on patients with an Accolade 1 stems in combination with a 36-mm or above LFIT or MITCH head, and for these patients to have clinical and radiological review.

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