Cooper, J Bone Joint Surg Am 2012 - Corrosion at the Head-Neck Taper as a Cause for Adverse Local Tissue Reactions after Total Hip Arthroplasty

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Corrosion at the Head-Neck Taper as a Cause for Adverse Local Tissue Reactions after Total Hip Arthroplasty

Cooper, Jacobs, et al.·J Bone Joint Surg Am·2012·589 citations·Retrospective cohort

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Background

Corrosion at the modular head-neck junction of the femoral component in total hip arthroplasty has been identified as a potential concern, although symptomatic adverse local tissue reactions secondary to corrosion have rarely been described.

Methods

We retrospectively reviewed the records of 10 patients with a metal-on-polyethylene total hip prosthesis, from 3 different manufacturers, who underwent revision surgery for corrosion at the modular head-neck junction.

Results

All patients presented with pain or swelling around the hip, and two patients presented with recurrent instability.
Serum cobalt levels were elevated prior to the revision arthroplasty and were typically more elevated than were serum chromium levels.
Surgical findings included large soft-tissue masses and surrounding tissue damage with visible corrosion at the femoral head-neck junction; the two patients who presented with instability had severe damage to the hip abductor musculature.
Pathology specimens consistently demonstrated areas of tissue necrosis.
The patients were treated with debridement and a femoral head and liner exchange, with use of a ceramic femoral head with a titanium sleeve in eight cases.
The mean Harris hip score improved from 58.1 points preoperatively to 89.7 points at a mean of 13.0 months after the revision surgery (p=0.01).
Repeat serum cobalt levels, measured in six patients at a mean of 8.0 months following revision, decreased to a mean of 1.61 ng/mL, and chromium levels were similar to prerevision levels.
One patient with moderate hip abductor muscle necrosis developed recurrent instability after revision and required a second revision arthroplasty.

Conclusions

Adverse local tissue reactions can occur in patients with a metal-on-polyethylene bearing secondary to corrosion at the modular femoral head-neck taper, and their presentation is similar to the adverse local tissue reactions seen in patients with a metal-on-metal bearing. Elevated serum metal levels, particularly a differential elevation of serum cobalt levels with respect to chromium levels, can be helpful in establishing this diagnosis.

Copyright remains with the authors and publisher.

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Corrosion at the Head-Neck Taper as a Cause for Adverse Local Tissue Reactions after Total Hip Arthroplasty

Cooper, Jacobs, et al.·J Bone Joint Surg Am·2012·589 citations·Retrospective cohort

Free Full Text·DOI·PubMed

|

Background

Corrosion at the modular head-neck junction of the femoral component in total hip arthroplasty has been identified as a potential concern, although symptomatic adverse local tissue reactions secondary to corrosion have rarely been described.

Methods

We retrospectively reviewed the records of 10 patients with a metal-on-polyethylene total hip prosthesis, from 3 different manufacturers, who underwent revision surgery for corrosion at the modular head-neck junction.

Results

All patients presented with pain or swelling around the hip, and two patients presented with recurrent instability.
Serum cobalt levels were elevated prior to the revision arthroplasty and were typically more elevated than were serum chromium levels.
Surgical findings included large soft-tissue masses and surrounding tissue damage with visible corrosion at the femoral head-neck junction; the two patients who presented with instability had severe damage to the hip abductor musculature.
Pathology specimens consistently demonstrated areas of tissue necrosis.
The patients were treated with debridement and a femoral head and liner exchange, with use of a ceramic femoral head with a titanium sleeve in eight cases.
The mean Harris hip score improved from 58.1 points preoperatively to 89.7 points at a mean of 13.0 months after the revision surgery (p=0.01).
Repeat serum cobalt levels, measured in six patients at a mean of 8.0 months following revision, decreased to a mean of 1.61 ng/mL, and chromium levels were similar to prerevision levels.
One patient with moderate hip abductor muscle necrosis developed recurrent instability after revision and required a second revision arthroplasty.

Conclusions

Adverse local tissue reactions can occur in patients with a metal-on-polyethylene bearing secondary to corrosion at the modular femoral head-neck taper, and their presentation is similar to the adverse local tissue reactions seen in patients with a metal-on-metal bearing. Elevated serum metal levels, particularly a differential elevation of serum cobalt levels with respect to chromium levels, can be helpful in establishing this diagnosis.

Copyright remains with the authors and publisher.

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