Abstract
Introduction
Corrosion products from modular taper junctions of hip prostheses have been implicated in adverse local tissue reactions after THR. Numerous factors have been proposed as the root causes of this phenomenon, including implant design and materials, manufacturing variables, intraoperative assembly, and patient lifestyle. As significant taper damage only occurs in a few percent of cases of THR, we have addressed this complication using a “forensic” examination of retrieval specimens to gain insight into the factors initiating the cascade leading to irreversible damage of the modular interface. In this study we report the categorization of over 380 retrievals into groups having shared damage patterns, metallic composition, and interface surface geometries to isolate the genesis of mechanically-assisted corrosion and its relation to intraoperative assembly, manufacturing, and postoperative loading.
Methods
A total of 384 femoral components were examined after retrieval at revision THR. The implants were produced by a diverse range of manufacturers, 271 in CoCr, and 113 in TiAlV, with both smooth (253) and machined (131) tapers. Initially, the implants were sorted into groups based on composition and taper roughness. Each trunnion was then cleaned to remove organic deposits and examined by stereomicroscopy at X6-X31. After an initial pilot study, we developed a classification system consisting of 8 basic patterns of damage (Table 1). We then classified all 384 trunnions according to this 8-group system. The prevalence of each pattern was calculated on the basis of both composition and surface texture of the trunnion.
Results
Overall, 81% of the trunnions had visible areas of surface damage, which varied as a function of composition (CoCr: 77%; TiAlV: 90%; p=0.002) and finish (smooth: 88%; machined: 67%; p<0.001). The most common pattern of damage was a circumferential ring at the base of the taper (24%) followed by a group with slight fretting or assembly damage distributed over the entire taper (19%). Damage to one quadrant at the bottom third was seen in approximately 18%. When combining material types, 41% of smooth tapers had circumferential patterns of damage corresponding to groups 2, 3, and 5. Conversely, 77% of the machined tapers had damage limited to one side or on two opposite sides (Patterns 4, 6, 7, 8, and 9).
Discussion
Our results show that the pattern and location of damage is influenced not only by composition and surface texture, but can also be an indicator of component fit. The damage patterns observed on almost half (45%) of the trunnions were not circumferential (Chart 2), suggesting that misalignment of the head during assembly may be responsible for initiating the corrosion cascade in stems with machined taper surfaces.
Summary
We categorized over 380 implant retrievals into groups having shared damage patterns, metallic composition, and interface surface geometries to isolate the genesis of corrosion.
