Adverse tissue reactions to wear particles from Co-alloy articulations, increased by alumina-blasting particle contamination from cementless Ti-based total hip implants

Total hip arthroplasty (THA) is an increasingly common procedure that replaces all or part of the hip joint. The average age of patients is decreasing, which in turn increases the need for more durable implants. Revisions in hip implants are frequently caused by three primary issues: femoral loading, poor fixation, and stress shielding. First, as the age of hip implant patients decreases, the hip implants are seeing increased loading, beyond what they were traditionally designed for. Second, traditional implants may have roughened surfaces but are not fully porous which would allow bone to grow in and through the implant. Third, traditional implants are too stiff, causing more load to be carried by the implant and shielding the bone from stress. Ultimately this stress shielding leads to bone resorption and implant loosening. Additive manufacturing (AM) presents a unique opportunity for enhanced performance by allowing for personalized medicine and increased functionality through geometrically complex parts. Much research has been devoted to how AM can be used to improve surgical implants through lattice structures. To date, the authors have found no studies that have performed a complete 3D lattice structure optimization in patient specific anatomy. This paper discusses the general design of an AM hip implant that is personalized for patient specific anatomy and proposes a workflow for optimizing a lattice structure within the implant. Using this design workflow, several lattice structured AM hip implants of various unit cell types are optimized. A solid hip implant is compared against the optimized hip implants. It appears the AM hip implant with a tetra lattice outperforms the other implant by reducing stiffness and allowing for greater bone ingrowth. Ultimately it was found that AM software still has many limitations associated with attempting complex optimizations with multiple materials in patient specific anatomy. Though software limitations prevented a full 3D optimization in patient specific anatomy, the challenges associated such an approach and limitations of the current software are discussed.

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Failure of total hip implants: metals and metal release in 52 cases

Contact Dermatitis ◽

10.1111/cod.12275 ◽

2014 ◽

Vol 71 (6) ◽

pp. 319-325 ◽

Cited By ~ 20

Author(s):

Stig S. Jakobsen ◽

Carola Lidén ◽

Kjeld Søballe ◽

Jeanne D. Johansen ◽

Torkil Menné ◽

...

Keyword(s):

Hip Implants ◽

Metal Release ◽

Total Hip

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Precoated Total Hip Implants

Orthopedics: Seeking a Balance ◽

10.5005/jp/books/11546_79 ◽

2012 ◽

pp. 207-207

Author(s):

Augusto Sarmiento

Keyword(s):

Hip Implants ◽

Total Hip

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Midterm outcomes of total hip arthroplasty with a modular Birmingham head

Hip International ◽

10.1177/1120700019877389 ◽

2019 ◽

pp. 112070001987738 ◽

Cited By ~ 1

Author(s):

Duncan W Cushnie ◽

Brent A Lanting ◽

Richard McCalden ◽

Douglas DR Naudie ◽

James L Howard

Keyword(s):

Soft Tissue ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Stem ◽

Tissue Reaction ◽

Harris Hip Score ◽

Total Hip ◽

Tissue Reactions ◽

Clinical Records

Introduction: Birmingham Hip Resurfacing (BHR) implants may be combined with a conventional femoral stem to create a modular metal-on-metal total hip arthroplasty (BHR MoM THA). There is little outcome data regarding this construct. This study examines midterm outcomes of BHR MoM THA compared to oxidised zirconium total hip arthroplasty (THA). Methods: A retrospective institutional review identified all patients receiving BHR MoM THA between April 2005 and February 2011 and a matched control cohort of zirconium THA patients. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Harris Hip Score (HHS), and SF-12 Health status scores were obtained. Revisions and complications were collected from clinical records. Radiographs were assessed for evidence of component malposition, loosening, osteolysis, or heterotopic ossification. Results: 63 modular BHR MoM THA were identified in 61 patients (36 with BHR cups, 27 with R3 cups) and 63 zirconium THA in 58 matched controls. Mean follow-up was 58 months. 14 BHR MoM THA hips (22.2%) were revised (4 infections, 1 dislocation, 9 soft tissue reactions) compared to 3 (4.8%) zirconium THA (all infections). At latest follow-up, 18.4% of surviving BHR MoM THA hips were painful compared to 0.5% of zirconium THA controls ( p < 0.001). WOMAC, HHS, and SF-12 did not differ significantly between surviving members of the 2 groups. Discussion: BHR MoM THA demonstrated a high revision rate, largely for adverse local soft tissue reaction and pain. Among those not revised, many reported some residual pain despite similar quality of life measures to those who received zirconium THA.

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Uniformly low serum cobalt levels after modular dual-mobility total hip arthroplasties with ceramic heads

The Bone & Joint Journal ◽

10.1302/0301-620x.101b6.bjj-2018-1403.r1 ◽

2019 ◽

Vol 101-B (6_Supple_B) ◽

pp. 57-61 ◽

Cited By ~ 9

Author(s):

B. P. Chalmers ◽

D. G. Mangold ◽

A. D. Hanssen ◽

M. W. Pagnano ◽

R. T. Trousdale ◽

...

Keyword(s):

Femoral Head ◽

Periprosthetic Femoral Fracture ◽

Dual Mobility ◽

Total Hip ◽

Primary Thas ◽

Ceramic Femoral Head ◽

The Mean ◽

Level 1 ◽

Tissue Reactions

Aims Modular dual-mobility constructs reduce the risk of dislocation after revision total hip arthroplasty (THA). However, questions about metal ions from the cobalt-chromium (CoCr) liner persist, and are particularly germane to patients being revised for adverse local tissue reactions (ALTR) to metal. We determined the early- to mid-term serum Co and Cr levels after modular dual-mobility components were used in revision and complex primary THAs, and specifically included patients revised for ALTR. Patients and Methods Serum Co and Cr levels were measured prospectively in 24 patients with a modular dual-mobility construct and a ceramic femoral head. Patients with CoCr heads or contralateral THAs with CoCr heads were excluded. The mean age was 63 years (35 to 83), with 13 patients (54%) being female. The mean follow-up was four years (2 to 7). Indications for modular dual-mobility were prosthetic joint infection treated with two-stage exchange and subsequent reimplantation (n = 8), ALTR revision (n = 7), complex primary THA (n = 7), recurrent instability (n = 1), and periprosthetic femoral fracture (n = 1). The mean preoperative Co and Cr in patients revised for an ALTR were 29.7 μg/l (2 to 146) and 21.5 μg/l (1 to 113), respectively. Results Mean Co and Cr levels were 0.30 μg/l and 0.76 μg/l, respectively, at the most recent follow-up. No patient had a Co level ≥ 1 μg/l. Only one patient had a Cr level ≥ 1 μg/l. That patient’s Cr level was 12 μg/l at 57 months after revision THA for ALTR (and decreased ten-fold from a preoperative Cr of 113 μg/l). Conclusion At a mean of four years, no patient with a modular dual-mobility construct and ceramic femoral head had elevated Co levels, including seven patients revised specifically for ALTR. While further studies are required, we support the selective use of a modular dual-mobility construct in revision and complex primary THAs for patients at high risk for instability. Cite this article: Bone Joint J 2019;101-B(6 Supple B):57–61.

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Compliant interfaces and fretting corrosion of modular taper junctions in total hip implants: The micromechanics of contact

Tribology International ◽

10.1016/j.triboint.2020.106437 ◽

2020 ◽

Vol 151 ◽

pp. 106437 ◽

Cited By ~ 2

Author(s):

Stephanie M. Smith ◽

Jeremy L. Gilbert

Keyword(s):

Hip Implants ◽

Fretting Corrosion ◽

Total Hip

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Wear particles induce a new macrophage phenotype with the potential to accelerate material corrosion within total hip replacement interfaces

Acta Biomaterialia ◽

10.1016/j.actbio.2019.10.039 ◽

2020 ◽

Vol 101 ◽

pp. 586-597 ◽

Cited By ~ 4

Author(s):

Divya Rani Bijukumar ◽

Shruti Salunkhe ◽

Guoxing Zheng ◽

Mark Barba ◽

Deborah J. Hall ◽

...

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Wear Particles ◽

Macrophage Phenotype ◽

Total Hip

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Wear of the high-density polyethylene socket in total hip arthroplasty and its role in endosteal cavitation

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/0954411971534737 ◽

1997 ◽

Vol 211 (1) ◽

pp. 109-118 ◽

Cited By ~ 21

Author(s):

B M Wroblewski

Keyword(s):

Hip Replacement ◽

High Density Polyethylene ◽

High Density ◽

Wear Particles ◽

Total Hip ◽

Weakest Link ◽

Ultimate Cause ◽

Cause Of Failure ◽

Secondary Healing

High-density polyethylene (HDP) has been used in clinical practice in total hip replacement since its introduction by Charnley in November 1962. Fears are being expressed that this may be the weakest link and the ultimate cause of failure of the arthroplasty. Long-term clinical experience suggests that loosening may be the primary cause while the presence of HDP wear particles is secondary. Healing of endosteal cavities can take place in the presence of HDP wear particles.

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