Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series
Keywords:hip, arthroplasty, taper, metallurgy, titanium alloy, corrosion, trunnion, revision
We describe four patients who were treated with primary total hip arthroplasty (THA) at two tertiary academic Australian teaching hospitals that experienced premature failure of head-neck trunnions through dissociation of the head-neck taper junction. This retrospective case series have similar clinical presentations and macroscopic pathology with severe head-neck taper junction loss of material, corrosion and early catastrophic failure. It is proposed that the accelerated wear is related to use of varus offset neck in a proprietary beta titanium alloy (Ti-12Mo-6Zr-2Fe or TMZFÒ Stryker Osteonics, Mahwah NJ, USA) TMZF femoral stem, longer head-neck combination in a relatively active, older, male patient population. In this limited case series presentation was on average 80 months (range 53-92) following index procedure. In three of the four patients, a prodromal period of groin or buttock pain was reported for between 1 week and 2 months prior to acute presentation. Significant metallosis and local tissue damage including gluteal muscle insufficiency was evident. Each stem revised was well fixed. An extended trochanteric osteotomy was required in two of the four cases for stem extraction. We recommend caution and further evaluation on the relationship between TMZF metal alloy and its longevity in higher demand patients with high neck offset, varus stem geometry and large CoCr bearing heads.
HJ Cooper, CJ Della Valle, RA Berger et al. Corrosion at the Head-Neck Taper as a Cause for Adverse Local Tissue Reactions After Total Hip Arthroplasty. J Bone Joint Surg Am, 2012 Sep 19; 94 (18):1655-1661.
McTighe T, Brazil D, Clarke I, Keppler L, Keggi j, Tkach T, McPherson E. Metallic Modular Taper Junctions in Total Hip Arthroplasty.
Wassef AJ, Schmalzried TP. Femoral taperosis: an accident waiting to happen?. Bone Joint J. 2013 Nov;95-B(11 Suppl A):3-6.
Langton DJ, Sidaginamale R, Lord JK, Nargol AVF, Joyce TJ. Taper junction failure in large-diameter metal-on-metal bearings. Bone & Joint Research. 2012;1(4):56-63.
Nassif NA, Nawabi DH, Stoner K, Elpers M, Wright T, Padgett DE. Taper Design Affects Failure of Large-head Metal-on-metal Total Hip Replacements. Clinical Orthopaedics and Related Research. 2014;472(2):564-571. doi:10.1007/s11999-013-3115-3.
Collier JP, Surprenant VA, Jensen RE, Mayor MB. Corrosion at the interface of cobalt-alloy heads on titanium-alloy stems. Clin Orthop Relat Res. 1991 Oct;(271):305-12.
Manthe M, Blasser K, Beauchamp C, O’Connor MI. Trunnion Corrosion Causing Failure in Metal-on-Polyethylene Total Hip Arthroplasty with Monolothic Femoral Components.
Goldberg JR, Gilbert JL, Jacobs JJ et al. A multicenter retrieval study of the taper interfaces of modular hip prostheses. Clin Orthop Relat Res. 2002 Aug;(401):149-61.
Gilbert JL, Buckley CA, Jacobs JJ. In vivo corrosion of modular hip prosthesis components in mixed and similar metal combinations. The effect of crevice, stress, motion, and alloy coupling. J Biomed Mater Res. 1993 Dec;27(12):1533-44.
Cook SD, Barrack RL, Clemow AJ. Corrosion and wear at the modular interface of uncemented femoral stems. J Bone Joint Surg Br. 1994 Jan;76(1):68-72.
Stryker Osteonics, TMZF Alloy: A Titanium Alloy Optimized for Orthoapaedic Implants. http://www.stryker.gr/st_pdf_ltmzfb.pdf (Accessed 10/8/2016).
Stryker Osteonics: Rejuvenate Modular / ABG II Modular-Neck Stem Voluntary Recall. http://www.stryker.com/en-us/products/Orthopaedics/modularneckstems/index.htm (Accessed 14/8/2016).
Australian Orthopaedic Association National Joint Replacement Registry, Annual Report 2015: Hip and Knee Arthroplasty. https://aoanjrr.sahmri.com/documents/10180/217745/Hip%20and%20Knee%20Arthroplasty. (Accessed 17/08/2016)
Jennings JM, Dennis DA, Yang CC. Corrosion of the Head-neck Junction After Total Hip Arthroplasty. J Am Acad Orthop Surg. 2016 Jun;24(6):349-56.
Munir S, Cross MB, Esposito C et al. Corrosion in modular total hip replacements: An analysis of the head–neck and stem–sleeve taper connections. Semin in Arthroplasty, Vol 24, Iss 4, 240-245.
Fricka KB, Ho H, Peace WJ, Engh CA Jr. Metal-on-metal local tissue reaction is associated with corrosion of the head taper junction. J Arthroplasty. 2012 Sep;27(8 Suppl):26-31.e1.
Huot Carlson JC, Van Citters DW, Currier JH et al. Femoral stem fracture and in vivo corrosion of retrieved modular femoral hips. J Arthroplasty. 2012 Aug;27(7):1389-1396.e1.
Pennock AT, Schmidt AH, Bourgeault CA. Morse-type tapers: factors that may influence taper strength during total hip arthroplasty. J Arthroplasty 2002 Sep;17(6):773-8
Donaldson FE, Coburn JC, Siegel KL. Total hip arthroplasty head-neck contact mechanics: a stochastic investigation of key parameters. J Biomech. 2014 May 7;47(7):1634-41.
Rehmer A, Bishop NE, Morlock MM. Influence of assembly procedure and material combination on the strength of the taper connection at the head-neck junction of modular hip endoprostheses. Clin Biomech (Bristol, Avon). 2012 Jan;27(1):77-83.
How to Cite
Copyright (c) 2016 Peter Walker, David Campbell, Paul Della Torre, Declan Brazil, Timothy McTighe
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.