Head Taper Corrosion Causing Head Bottoming Out and Consecutive Gross Stem Taper Failure in Total Hip Arthroplasty

摘要

BackgroundTaper corrosion in total hip arthroplasty for bearings with metal heads against polyethylene has developed from an anecdotal observation to a clinical problem. Increased taper wear and even gross taper failure have been reported for one particular design. It is hypothesized that corrosion of the female head taper results in taper widening, allowing the cobalt-chromium head to turn on the stem and wear down the softer titanium alloy by abrasive wear, ultimately causing failure. The purpose of this study is to investigate the time course of this process and the general role of taper dimensions and material in this problem. MethodsRetrieved cobalt-chromium alloy heads (n?= 30, LFIT; Stryker, Mahwah, NJ) and Ti-12Mo-6Zr-2Fe (TMZF) stems (n?= 10, Accolade I; Stryker) were available for analysis. Taper material loss was determined using three-dimensional coordinate measurements and scanning. The pristine tip clearance between head and stem was analytically determined. The influence of taper material and taper size on taper deformation and micromotion was investigated using a finite element model. ResultsMaterial loss at the head taper increased with time in situ up to a volume of 20.8 mm3(P< .001). A mean linear material loss above 76 μm at the head taper was analytically confirmed to result in bottoming out, which was observed in 12 heads. The finite element calculations showed significantly larger deformations and micromotions for a small 11/13 TMZF taper combined with a distinctly different micromotion pattern compared to other materials and taper designs. ConclusionA 11/13 TMZF taper design with 36-mm head diameters bears a higher risk for corrosion than larger tapers made from stiffer materials. Failures of this combination are not restricted to the head sizes included in the recall. Patients with this implant combination should be closely monitored.