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ASTM Selected Technical Papers
Modularity and Tapers in Total Joint Replacement Devices
By
A. Seth Greenwald, D.Phil.(Oxon)
A. Seth Greenwald, D.Phil.(Oxon)
Symposium Chairperson and STP Editor
1
Orthopaedic Research Laboratories
,
Cleveland, OH,
US
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Steven M. Kurtz, Ph.D.
Steven M. Kurtz, Ph.D.
Symposium Chairperson and STP Editor
2
Exponent, Inc.
,
Philadelphia, PA,
US
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Jack E. Lemons, Ph.D.
Jack E. Lemons, Ph.D.
Symposium Chairperson and STP Editor
3
University of Alabama at Birmingham
,
Birmingham, AL,
US
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William M. Mihalko, M.D., Ph.D.
William M. Mihalko, M.D., Ph.D.
Symposium Chairperson and STP Editor
4
Campbell Clinic Orthopaedics, University of Tennessee
,
Memphis, TN,
US
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ISBN:
978-0-8031-7627-0
No. of Pages:
463
Publisher:
ASTM International
Publication date:
2015

The purpose of this study was to characterize the prevalence of taper damage in retrieved modular shoulder arthroplasty components. We matched this cohort with historical and contemporary total hip replacements. The components were matched primarily for implantation time, but also for alloy combination (mixed versus similar) and patient age (as a proxy for patient activity), when available. Modular components were evaluated for mechanically assisted crevice corrosion using a semiquantitative four-point scoring system. In total, 92 anatomical humeral heads and 67 associated stems with an average implantation time of 4.6 ± 4.3 years were analyzed. Additionally, 79 femoral heads and 61 associated stems with an average implantation time of 4.5 ± 4.4 years were matched to shoulder components and analyzed. Design and patient factors were assessed as potential predictors of taper damage. Evidence of damage was observed on 46 % of humeral heads and 66 % of the humeral stems. In the hips, 47 % of femoral heads and 44 % of femoral stems had evidence of damage. Mixed alloy pairs (p < 0.0001; stem side only), taper rigidity (p < 0.0001), and implantation time (p = 0.01) were associated with taper corrosion. The results from this study supported the prevalence of taper damage that is similar between anatomical shoulder and conventional hip arthroplasty. The clinical implications of these findings have not yet been determined.

1.
Stuchin
,
S. A.
and
Frankel
,
V. H.
, “
Early Experience with the Autophor Prosthesis Using a Posterior Approach
,”
Yale J. Biol. Med.
, Vol.
57
, No.
6
,
1984
, pp. 843–850.
2.
Jacobs
,
J. J.
,
Gilbert
,
J. L.
, and
Urban
,
R. M.
, “
Corrosion of Metal Orthopaedic Implants
,”
J. Bone Joint Surg. Am.
, Vol.
80
, No.
2
,
1998
, pp. 268–282.
3.
Christie
,
M. J.
,
DeBoer
,
D. K.
,
Trick
,
L. W.
,
Brothers
,
J. C.
,
Jones
,
R. E.
,
Vise
,
G. T.
, and
Gruen
,
T. A.
, “
Primary Total Hip Arthroplasty with Use of the Modular S-ROM Prosthesis. Four to Seven-Year Clinical and Radiographic Results
,”
J. Bone Joint Surg. Am.
, Vol.
81
, No.
12
,
1999
, pp. 1707–1716.
4.
Kretzer
,
J. P.
,
Jakubowitz
,
E.
,
Krachler
,
M.
,
Thomsen
,
M.
, and
Heisel
,
C.
, “
Metal Release and Corrosion Effects of Modular Neck Total Hip Arthroplasty
,”
Int. Orthop.
, Vol.
33
, No.
6
,
2009
, pp. 1531–1536.
5.
Goldberg
,
J. R.
,
Gilbert
,
J. L.
,
Jacobs
,
J. J.
,
Bauer
,
T. W.
,
Paprosky
,
W.
, and
Leurgans
,
S.
, “
A Multicenter Retrieval Study of the Taper Interfaces of Modular Hip Prostheses
,”
Clin. Orthop. Relat. Res.
, Vol.
401
,
2002
, pp. 149–161.
6.
Huot Carlson
,
J. C.
,
Van Citters
,
D. W.
,
Currier
,
J. H.
,
Bryant
,
A. M.
,
Mayor
,
M. B.
, and
Collier
,
J. P.
, “
Femoral Stem Fracture and In vivo Corrosion of Retrieved Modular Femoral Hips
,”
J. Arthroplasty
, Vol.
27
, No.
7
,
2012
, pp. 1389–1396 e1.
7.
Cook
,
S. D.
,
Barrack
,
R. L.
,
Baffes
,
G. C.
,
Clemow
,
A. J.
,
Serekian
,
P.
,
Dong
,
N.
, and
Kester
,
M. A.
, “
Wear and Corrosion of Modular Interfaces in Total Hip Replacements
,”
Clin. Orthop. Relat. Res.
, Vol.
298
,
1994
, pp. 80–88.
8.
Dyrkacz
,
R. M.
,
Brandt
,
J. M.
,
Ojo
,
O. A.
,
Turgeon
,
T. R.
, and
Wyss
,
U. P.
, “
The Influence of Head Size on Corrosion and Fretting Behaviour at the Head-Neck Interface of Artificial Hip Joints
,”
J. Arthroplasty
, Vol.
28
, No.
6
,
2013
, pp. 1036–1340.
9.
Collier
,
J. P.
,
Surprenant
,
V. A.
,
Jensen
,
R. E.
, and
Mayor
,
M. B.
, “
Corrosion at the Interface of Cobalt-Alloy Heads on Titanium-Alloy Stems
,”
Clin. Orthop. Relat. Res.
, Vol.
271
,
1991
, pp. 305–312.
10.
Collier
,
J. P.
,
Surprenant
,
V. A.
,
Jensen
,
R. E.
,
Mayor
,
M. B.
, and
Surprenant
,
H. P.
, “
Corrosion Between the Components of Modular Femoral Hip Prostheses
,”
J. Bone Joint Surg. Brit.
, Vol.
74
, No.
4
,
1992
, pp. 511–517.
11.
Cook
,
S. D.
,
Barrack
,
R. L.
, and
Clemow
,
A. J.
, “
Corrosion and Wear at the Modular Interface of Uncemented Femoral Stems
,”
J. Bone Joint Surg. Brit.
, Vol.
76
, No.
1
,
1994
, pp. 68–72.
12.
Cook
,
S. D.
,
Gianoli
,
G. J.
,
Clemow
,
A. J.
, and
Haddad
,
R. J.
, Jr.
, “
Fretting Corrosion in Orthopaedic Alloys
,”
Biomater. Med. Devices Artif. Organs
, Vol.
11
, No.
4
,
1983
, pp. 281–292.
13.
Esposito
,
C. I.
,
Wright
,
T. M.
,
Goodman
,
S. B.
, and
Berry
,
D. J.
, “
What Is the Trouble with Trunnions?
,”
Clin. Orthop. Relat. Res.
, Vol.
472
, No.
12
,
2014
, pp. 3652–3658.
14.
Hallab
,
N. J.
,
Messina
,
C.
,
Skipor
,
A.
, and
Jacobs
,
J. J.
, “
Differences in the Fretting Corrosion of Metal-Metal and Ceramic-Metal Modular Junctions of Total Hip Replacements
,”
J. Orthop. Res.
, Vol.
22
, No.
2
,
2004
, pp. 250–259.
15.
Higgs
,
G. B.
,
Hanzlik
,
J. A.
,
MacDonald
,
D. W.
,
Gilbert
,
J. L.
,
Rimnac
,
C. M.
, and
Kurtz
,
S. M.
, “
Is Increased Modularity Associated with Increased Fretting and Corrosion Damage in Metal-on-Metal Total Hip Arthroplasty Devices? A Retrieval Study
,”
J. Arthroplasty
, Vol.
28
, No.
8 (Suppl.)
,
2013
, pp. 2–6.
16.
Jauch
,
S. Y.
,
Huber
,
G.
,
Sellenschloh
,
K.
,
Haschke
,
H.
,
Baxmann
,
M.
,
Grupp
,
T. M.
, and
Morlock
,
M. M.
, “
Micromotions at the Taper Interface Between Stem and Neck Adapter of a Bimodular Hip Prosthesis During Activities of Daily Living
,”
J. Orthop. Res.
, Vol.
31
, No.
8
,
2013
, pp. 1165–1171.
17.
Kurtz
,
S. M.
,
Kocagoz
,
S. B.
,
Hanzlik
,
J. A.
,
Underwood
,
R. J.
,
Gilbert
,
J. L.
,
MacDonald
,
D. W.
,
Lee
,
G. C.
,
Mont
,
M. A.
,
Kraay
,
M. J.
,
Klein
,
G. R.
,
Parvizi
,
J.
, and
Rimnac
,
C. M.
, “
Do Ceramic Femoral Heads Reduce Taper Fretting Corrosion in Hip Arthroplasty? A Retrieval Study
,”
Clin. Orthop. Relat. Res.
, Vol.
471
, No.
10
,
2013
, pp. 3270–3282.
18.
Mroczkowski
,
M. L.
,
Hertzler
,
J. S.
,
Humphrey
,
S. M.
,
Johnson
,
T.
, and
Blanchard
,
C. R.
, “
Effect of Impact Assembly on the Fretting Corrosion of Modular Hip Tapers
,”
J. Orthop. Res.
, Vol.
24
, No.
2
,
2006
, pp. 271–279.
19.
Nassif
,
N. A.
,
Nawabi
,
D. H.
,
Stoner
,
K.
,
Elpers
,
M.
,
Wright
,
T.
, and
Padgett
,
D. E.
, “
Taper Design Affects Failure of Large-Head Metal-on-Metal Total Hip Replacements
,”
Clin. Orthop. Relat. Res.
, Vol.
472
, No.
2
,
2014
, pp. 564–571.
20.
Panagiotidou
,
A.
,
Meswania
,
J.
,
Hua
,
J.
,
Muirhead-Allwood
,
S.
,
Hart
,
A.
, and
Blunn
,
G.
, “
Enhanced Wear and Corrosion in Modular Tapers in Total Hip Replacement Is Associated with the Contact Area and Surface Topography
,”
J. Orthop. Res.
, Vol.
31
, No.
12
,
2013
, pp. 2032–2039.
21.
Porter
,
D. A.
,
Urban
,
R. M.
,
Jacobs
,
J. J.
,
Gilbert
,
J. L.
,
Rodriguez
,
J. A.
, and
Cooper
,
H. J.
, “
Modern Trunnions Are More Flexible: A Mechanical Analysis of THA Taper Designs
,”
Clin. Orthop. Relat. Res.
, Vol.
472
, No.
12
,
2014
, pp. 3963–3970.
22.
Swaminathan
,
V.
and
Gilbert
,
J. L.
, “
Potential and Frequency Effects on Fretting Corrosion of Ti6Al4V and CoCrMo Surfaces
,”
J. Biomed. Mater. Res. A
, Vol.
101
, No.
9
,
2013
, pp. 2602–2612.
23.
Day
,
J. S.
,
Lau
,
E.
,
Ong
,
K. L.
,
Williams
,
G. R.
,
Ramsey
,
M. L.
, and
Kurtz
,
S. M.
, “
Prevalence and Projections of Total Shoulder and Elbow Arthroplasty in the United States to 2015
,”
J. Should. Elbow Surg.
, Vol.
19
, No.
8
,
2010
, pp. 1115–1120.
24.
Khan
,
W. S.
,
Agarwal
,
M.
,
Malik
,
A. A.
,
Cox
,
A. G.
,
Denton
,
J.
, and
Holt
,
E. M.
, “
Chromium, Cobalt and Titanium Metallosis Involving a Nottingham Shoulder Replacement
,”
J. Bone Joint Surg. Brit.
, Vol.
90
, No.
4
,
2008
, pp. 502–505.
25.
Lederman
,
E. S.
,
Nugent
,
M. T.
, and
Chhabra
,
A.
, “
Metallosis After Hemiarthroplasty as a Result of Glenoid Erosion Causing Contact with Retained Metallic Suture Anchors: A Case Series
,”
J. Should. Elbow Surg.
, Vol.
20
, No.
6
,
2011
, pp. e12–15.
26.
Jauch
,
S. Y.
,
Huber
,
G.
,
Haschke
,
H.
,
Sellenschloh
,
K.
, and
Morlock
,
M. M.
, “
Design Parameters and the Material Coupling Are Decisive for the Micromotion Magnitude at the Stem-Neck Interface of Bi-modular Hip Implants
,”
Med. Enging. Physics
, Vol.
36
, No.
3
,
2014
, pp. 300–307.
27.
Fricka
,
K. B.
,
Ho
,
H.
,
Peace
,
W. J.
, and
Engh
,
C. A.
, Jr.
, “
Metal-on-Metal Local Tissue Reaction Is Associated with Corrosion of the Head Taper Junction
,”
J. Arthroplasty
, Vol.
27
, No.
8 (Suppl.)
,
2012
, pp. 26–31 e1.
28.
Molloy
,
D. O.
,
Munir
,
S.
,
Jack
,
C. M.
,
Cross
,
M. B.
,
Walter
,
W. L.
, and
Walter
,
W. K.
, Sr.
, “
Fretting and Corrosion in Modular-Neck Total Hip Arthroplasty Femoral Stems
,”
J. Bone Joint Surg. Am.
, Vol.
96
, No.
6
,
2014
, pp. 488–493.
29.
Jauch
,
S. Y.
,
Huber
,
G.
,
Hoenig
,
E.
,
Baxmann
,
M.
,
Grupp
,
T. M.
, and
Morlock
,
M. M.
, “
Influence of Material Coupling and Assembly Condition on the Magnitude of Micromotion at the Stem-Neck Interface of a Modular Hip Endoprosthesis
,”
J. Biomech.
, Vol.
44
, No.
9
,
2011
, pp. 1747–1751.
30.
Pennock
,
A. T.
,
Schmidt
,
A. H.
, and
Bourgeault
,
C. A.
, “
Morse-Type Tapers: Factors That May Influence Taper Strength During Total Hip Arthroplasty
,”
J. Arthroplasty
, Vol.
17
, No.
6
,
2002
, pp. 773–778.
31.
Hothi
,
H. S.
,
Matthies
,
A. K.
,
Berber
,
R.
,
Whittaker
,
R. K.
,
Skinner
,
J. A.
, and
Hart
,
A. J.
, “
The Reliability of a Scoring System for Corrosion and Fretting, and Its Relationship to Material Loss of Tapered, Modular Junctions of Retrieved Hip Implants
,”
J. Arthroplasty
, Vol.
29
, No.
6
,
2014
, pp. 1313–1317.
32.
Meneghini
,
R. M.
,
Hallab
,
N. J.
, and
Jacobs
,
J. J.
, “
Evaluation and Treatment of Painful Total Hip Arthroplasties with Modular Metal Taper Junctions
,”
Orthopedics
, Vol.
35
, No.
5
,
2012
, pp. 386–391.
33.
Arnholt
,
C. M.
,
MacDonald
,
D. W.
,
Tohfafarosh
,
M.
,
Gilbert
,
J. L.
,
Rimnac
,
C. M.
,
Kurtz
,
S. M.
,
Implant Research Center Writing Committee
,
Klein
,
G.
,
Mont
,
M. A.
,
Parvizi
,
J.
,
Cates
,
H. E.
,
Lee
,
G. C.
,
Malkani
,
A.
, and
Kraay
,
M.
, “
Mechanically Assisted Taper Corrosion in Modular TKA
,”
J. Arthroplasty
, Vol.
29
, No.
9 (Suppl.)
,
2014
, pp. 205–208.
34.
Bergmann
,
G.
,
Graichen
,
F.
,
Bender
,
A.
,
Kaab
,
M.
,
Rohlmann
,
A.
, and
Westerhoff
,
P.
, “
In Vivo Glenohumeral Contact Forces—Measurements in the First Patient 7 Months Postoperatively
,”
J. Biomech.
, Vol.
40
, No.
10
,
2007
, pp. 2139–2149.
35.
Bergmann
,
G.
,
Graichen
,
F.
,
Bender
,
A.
,
Rohlmann
,
A.
,
Halder
,
A.
,
Beier
,
A.
, and
Westerhoff
,
P.
, “
In Vivo Gleno-Humeral Joint Loads During Forward Flexion and Abduction
,”
J. Biomech.
, Vol.
44
, No.
8
,
2011
, pp. 1543–1552.
36.
Westerhoff
,
P.
,
Graichen
,
F.
,
Bender
,
A.
,
Halder
,
A.
,
Beier
,
A.
,
Rohlmann
,
A.
, and
Bergmann
,
G.
, “
In vivo Measurement of Shoulder Joint Loads During Activities of Daily Living
,”
J. Biomech.
, Vol.
42
,
2009
, pp. 1840–1849.
37.
Anglin
,
C.
,
Wyss
,
U. P.
, and
Pichora
,
D. R.
, “
Mechanical Testing of Shoulder Prostheses and Recommendations for Glenoid Design
,”
J. Should. Elbow Surg.
, Vol.
9
, No.
4
,
2000
, pp. 323–331.
38.
Bergmann
,
G.
,
Deuretzbacher
,
G.
,
Heller
,
M.
,
Graichen
,
F.
,
Rohlmann
,
A.
,
Strauss
,
J.
, and
Duda
,
G. N.
, “
Hip Contact Forces and Gait Patterns from Routine Activities
,”
J. Biomech.
, Vol.
34
, No.
7
,
2001
, pp. 859–871.
39.
Bergmann
,
G.
,
Graichen
,
F.
,
Rohlmann
,
A.
,
Bender
,
A.
,
Heinlein
,
B.
,
Duda
,
G. N.
,
Heller
,
M. O.
, and
Morlock
,
M. M.
, “
Realistic Loads for Testing Hip Implants
,”
Biomed. Mater. Enging.
, Vol.
20
, No.
2
,
2010
, pp. 65–75.
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