Metallic Modular Taper Junctions in Total Hip Arthroplasty
The emergence of modularity in total hip arthroplasty (THA) in the 1980s and 1990s was based on the fact that the benefit of these design features outweighed the risk. The use of metallic modular junctions presents a unique set of advantages and problems for use in THA. The advantages include improvement in fit and fill of the implant to bone, restoration of joint mechanics, reduced complications in revision surgery and reduction of costly inventory. However, the risks or concerns are a little harder to identify and deal with. Certainly corrosion, and fatigue failure are the two most prevalent concerns but now the specifics of fretting wear and corrosive wear increasing particulate debris and the potential biological response is having an impact on the design and potential longevity of the reconstructed hip. Material and designs are facing a shorter life expectancy than what was previously thought, mostly due to an increasing level of physical activity by the patient. Because there are no accurate laboratory test whereby the service life and performance of these implants can be predicted, early controlled clinical evaluations are necessary. Early publication of testing and clinical impressions should be encouraged in an attempt to reduce exposure to potential at risk patients, implants and material. The reduction and possible elimination of risks will require a balancing of all the variables requiring a multidisciplinary endeavor.
This paper is designed to review the risk factors, and benefits of modular junctions in total hip arthroplasty (THA). Also some basic engineering principals that can reduce risk factors and improve functionality of modular junctions.
Cameron H, Trick L, Shepherd B, et al. An international multi-center study on thigh pain in total hip replacements. American Academy of Orthopaedic Surgeons 1991 Scientific Exhibit, New Orleans, Louisiana. DOI: http://dx.doi.org/10.13140/RG.2.1.2093.2641
Mattingly D, McCarthy J, et al. Revising the deficient proximal femur. American Academy of Orthopaedic Surgeons 1991 Scientific Exhibit, Anaheim, CA. DOI:http://dx.doi.org/10.13140/2.1.3611.7289
Keppler L, Cameron H, McTighe T. The Role of Modularity in Primary THA: Is There One? American Academy of Orthopaedic Surgeons 2006 Scientific Exhibit, Chicago, IL. DOI: http://dx.doi.org/10.13140/RG.2.1.2132.5923
Tkach T, Low W, Cipolletti G, McTighe T. Target Restoration of Hip Mechanics in THA. American Academy of Orthopaedic Surgeons 2006 Scientific Exhibit, Chicago, IL. DOI: http://dx.doi.org/10.13140/RG.2.1.1084.0167.
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;27:1533–1544.
Berry DJ. Utility of modular implants in primary total hip arthroplasty. The Journal of Arthroplasty 2014;29:657-658
McTighe T, Brazil D, Keggi J, Keppler L, et al. Optimizing modular tapers for total hip arthroplasty. http://www.jisrf.org/pdfs/Optimizing-Modular-Tapers-for-Total-Hip-Arthroplasty-ICJR-July2014.pdf. Conference Paper July 2014: International Congress for Joint Reconstruction, Pacific Hilton Waikoloa Village Resort.
McTighe T, Brazil D, Bruce W. Metallic Alloys in Total Hip Arthroplasty. In: Cashman J, Goyal N, Parvizi J, eds. The Hip: Preservation, Replacement and Revision. Baltimore, MD: Data Trace Publishing Company; 2015:14-1–14-12.
McTighe T. Cementless Modular Stems. JISRF Update, April, 2002 http://www.jisrf.org/pdfs/cementless-modular-stems.pdf
Bobyn JD, Collier JP, et al., Particulate Debirs in Total Hip Arthroplasty: Problems and Solutions. American Academy of Orthopaedic Surgeons 1993 Scientific Exhibit. DOI: http://dx.doi.org/10.13140/RG.2.1.2355.4080
Chana R, Esposito C, Campbell PA, et al. Mixing and matching causing taper wear: corrosion associated with pseudotumour formation. J Bone Joint Surg Br 2012;94:281.
Cooper HJ. The local effects of metal corrosion in total hip arthroplasty. Orthop Clin N Am 2014;45(1):9.
Keggi K, Keggi J, Kennon R, et al. Within any important issue, there are always aspects no one wishes to discuss: femoral component failure. Poster Exhibit International Society for Technology in Arthroplasty, October 2006. DOI: http://dx.doi.org/10.13140/RG.2.1.4779.6329 ·
Bechtol CO, Ferguson AB Jr, Laing PG. Metals and Engineering in Bone and Joint Surgery. Baltimore: Williams and Wilkins Company, 1959
Willert, H.G. and Semlitsch, M.: Reactions of the articular capsule to wear products of artificial joint prostheses. J. Biomed. Meter. Res. 11:157, 1977.
16Kutz SM, Ong K, et al., Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. JBJS 89(4):780-5 March 2007 DOI: http://dx.doi.org/10.2106/JBJS.F.00222 Source: PubMed
McTighe T, Trick L, Koeneman J. Design Considerations for Cementless Total Hip Arthroplasty. Encyclopedic Handbook of Biomaterials and Bioengineering. Part B Applications Vol I. Marcel Dekker, Inc. 1995 DOI: http://dx.doi.org/10.13140/RG.2.1.2919.0240.
Kwon YM, Ostlere SJ, McLardy-Smith P et-al. “Asymptomatic” pseudotumors after metal-on-metal hip resurfacing arthroplasty: prevalence and metal ion study. J Arthroplasty. 2011;26 (4):511-8. DOI: http://dx.doi.org/10.1016/j.arth.2010.05.030.
Clarke M, Lee P, Aron A, Villar R. Levels of metal ions after small- and large- diameter metal-on-metal hip arthroplasty. J Bone Joint Surg [Br] 2003;85-B:913-7, Received 14 January 2003; Accepted 27 May 2003
Innman M, Gotterbarm T, et al. Minimum ten-year results of a 28-mm metal-on-metal bearing in cementless total hip arthroplasty in patients fifty years of age and younger. International Orthopaedics May 2014, Volume 38, Issue 5, pp 929-934
Migaud H, Berton C, et al. Head Size and Metal-on-Metal Bearings. Total Hip Arthroplasty 2013, pp 125-140, Springer Berlin Heidelberg 10.1007/978-3-642-35653-7_12
McDougall A. Malignant tumour at site of bone plating. J Bone Joint Surg Br. 1956;38(3):709-713.
Jacobs JJ, Gilbert JL, Urban RM. Corrosion of metal orthopaedic Implants. J Bone Joint Surg Am. 1998;80(2):268-282
National Joint Registry. 7th Annual Report for England and Wales. 2010. www.njrreports.org.uk; www.njrcentre.org.uk.
Morlock M. The taper disaster: How could it happen? Hip Int 2015;May 20(00):000- 000 DOI: http://dx.doi.org/10.5301/hipint.5000269
Langton DJ, Jameson SS, Joyce TJ, Hallab NJ, Natu S, Nargol AV. Early failure of metal-on-metal bearings in hip resurfacing and large-diameter total hip replacement: A consequence of excess wear. J Bone Joint Surg Br. 2010;92(1):38-46.
Hernigou P, Queinnec S, Lachaniette C. One hundred and fifty years of history of the Morse taper: from Stephen A. Morse in 1864 to complications related to modularity in hip arthroplasty. International Orthopaedics 2013;37:2081–2088 DOI: http://dx.doi.org/10.1007/s00264- 013-1927-0.
Scheuber L, Usbeck S, Petkow F. The Neck Taper in Hip Arthroplasty-What does the surgeon have to consider? CeramTec Publication, CeraNews 1/2014
Keggi K, Keggi J, Kennon R, McTighe T. Ceramic on Ceramic Bearings Used with Proximal Modular Stems in THA. Bioceramics in Joint Arthroplasty/Ceramics in Orthopaedics 2004:3-8 DOI: http://dx.doi.org/10.13140/RG.2.1.3403.9846
Langton et al. Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg [Br] 2011;93-B:1011-16
Barrack R, Burke D, et al. Complications Related to Modularity of Total Hip Components. J Bone Joint Surg [Br] 1993; 75-B:688-92
NASA Corrosion Technology Laboratory. Forms of Corrosion. Available http://corrosion.ksc.nasa.gov/corr_forms.htm.
Pastides P, Dodd M, Sarraf K, Willis-Owen C. Trunnionosis: A pain in the neck. World J Orthop 2013 Oct 18;4(4):161-166 DOI: http://dx.doi.org/10.5312/wjo.v4.i4.161.
Modular Neck Stem Voluntary Recall Information. Available at http://www.aboutstryker.com/modularneckstems/.
Pivec R, Meneghini M, Hozack W, et al. Modular Taper Junction Corrosion and failure: How to Approach a Recalled Total Hip Arthroplasty Implant. J Arthroplasty. 2014;29(1):1-6.
McTighe T, Brazil D, Keggi J, Keppler L, et al. Short-Stem Designs for Total Hip Arthroplasty: Neck Stabilized Femoral Components. In Callaghan J, Beaule P, Clohisy J, et al. The Adult Hip. 3rd ed. Philadelphia: Wolters Kluwer Health, in press.
Brazil D, McTighe T. Taper Issues in Total Hip Arthroplasty. Oral Paper, 2014 International Congress for Joint Reconstruction, CME Meeting, Sydney, Australia. DOI: http://dx.doi.org/10.13140/2.1.1748.2889
Keppler L, Cameron HU, McTighe T. The role of modularity in primary THA: Is there one? AAOS 2006 Scientific Exhibit, Chicago, IL http://www.jisrf.org/pdfs/modulartity-primary-tha.pdf. J Arthroplasty 2006; 21(4 Suppl 1):89-92.
Design features and early clinical Results with a modular proximally fixed low bending stiffness uncemented total hip replacement. AAOS 1998 Scientific Exhibit, Atlanta, GA. DOI: http://dx.doi.org/10.13140/RG.2.1.4714.7040.
Pearce S, Jenabzadeh A, Walter W, et al. Spontaneous fracture of diaphyseal stem of S-ROM femoral prosthesis. BMJ Case Reports 2014; DOI:http://dx.doi.org/10.1136/bcr-2013-202813.
Waly F, Abduljabber FH, Gascoyne T, et al. Stem-sleeve junction failure of a modular hip system: a retrieval analysis. HSS Journal Case Report. DOI: http://dx.doi.org/10.1007/s11420-015-9455-7. Published online July 9, 2015.
Patel A, Bliss J, Calfee RP, et al. Modular femoral-sleeve junction failure after primary total hip arthroplasty. JArthroplasty, 2009;24(7):1143. E1-5. DOI: http://dx.doi.org/10.1016/j.arth.2008.09.006.
Urban RM, Gilbert JL, Jacobs J. Corrosion and corrosion products generated by three designs of cementless hip stems with a ti-alloy/ti-alloy modular-body junction. 53rd Annual Meeting of the Orthopaedic Research Society, Paper No: 0277.
Grose A, Gonzalez A, Bullough P, et al. High failure rate of a modern, proximally roughened, cemented stem for total hip arthroplasty. Int Orthop. 2006;30(4):243–247.
Collis DK, Mohler CG. Comparison of clinical outcomes in total hip arthroplasty using rough and polished cemented stems with essentially the same geometry. J Bone Joint Surg Am 2002;84–A:586–592.
Buly RL, Hou MH, Salvati E, et al. Titanium wear debris in failed cemented total hip arthroplasty. An analysis of 71 cases. J Arthroplasty. 1992;7(3):315-23.
Copyright (c) 2015 Timothy McTighe, Declan Brazil, Louis Keppler, John Keggi, Edward McPherson
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.