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Corrosion of modular hip prostheses.

Fracture of the femoral prosthesis in total hip replacement according to charnley.

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One paper reported 2 cases of intergranular corrosion-fatigue failure of modular hip systems, both occurring in heavy, quite active patients at 70 months and 85 months postsurgery [].

Corrosion-induced fracture of a double-modular hip prosthesis: a case report.

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A study showed that 16–35% of retrieved modular total hip implants showed signs of moderate-to-severe corrosion at the taper [].

The optimal method of fixation for primary total hip replacements (THR), particularly fixation with or without the use of cement is still controversial. In a systematic review and metaanalysis of all randomized controlled trials comparing cemented uncemented THRS available in the published literature, we found that there is no significant difference between cemented and uncemented THRs in terms of implant survival as measured by the revision rate. Better short-term clinical outcome, particularly an improved pain score can be obtained with cemented fixation. However, the results are unclear for the long-term clinical and functional outcome between the two groups. No difference was evident in the mortality and the post operative complication rate. On the other hand, the radiographic findings were variable and do not seem to correlate with clinical findings as differences in the surgical technique and prosthesis design might be associated with the incidence of osteolysis. We concluded in our review that cemented THR is similar if not superior to uncemented THR, and provides better short term clinical outcomes. Further research, improved methodology and longer follow up are necessary to better define specific subgroups of patients in whom the relative benefits of cemented and uncemented implant fixation can be clearly demonstrated.

The primary outcome is failure of the primary procedure, measured objectively by the revision rate due to aseptic loosening of either the cup or the stem. Secondary outcomes included radiological signs of loosening or osteolysis, mortality, complications, pain score, functional scores mainly Harris Hip Score (HHS) and Merle-D'Aubigne score, follow up duration and radiostereometric analysis (RSA).

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In a recent literature review Clement concluded that cemented fixation remains gold standard for the acetabulum as the overall and all cause reoperation risk was lower for cemented fixation. Pavkis showed no difference e in the complications, wear, osteolysis, migration and clinical scores when they looked at only RCTs in their systematic review of literature. Non RCT studies revealed better osteolysis, migration properties and aseptic loosening survival for uncemented acetabular components. However in terms of wear and overall survival favored the cemented acetabular components. In a RCT involving 240 THRs Bjørgul found that at 10-years follow up that there was no clinical and radiological difference between the cemented Charnley cup and the uncemented Duraloc cup. All had received a cemented Charnley stem. There was similarly no difference in the implant survival at 12–14 yeas follow up. A more recent RCT involving 250 patients with a minimum 17 year follow-up showed lower survival rates of cemented compared with cementless THA with Kaplan-Meier survivorship analysis at 20 years. Age less than 65years and male gender were significantly predictive for risk of revision surgery.

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In vivo corrosion of modular hip prosthesis components in mixed and similar metal combinations: the effect of crevice, stress, motion, and alloy coupling.

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However, the increased use of modular hip systems has led to concerns regarding the risk of corrosion at the taper [–], leading to implant failure [, ].

PINNACLE® Hip Solutions - DePuy Synthes

Image showing an uncemented hip stem (the Corail stem). The textured surface of this titanium stem is covered with a layer of hydroxyapatite to encourage the patients bone to grow onto the implant.

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