Potentiodynamic Corrosion Testing

Different metallic materials have different polarization characteristics as dictated by the open circuit potential, breakdown potential, and passivation ...

Prince of Wales Clinical School

During total hip arthroplasty, use of a modular femoral neck on a stemmed implant allows optimization of neck anteversion, length, and offset, resulting in more accurate balance. We performed a retrospective analysis of a consecutive cohort of patients who had undergone total hip arthroplasty with a modular-neck hip system with ceramic-on-ceramic bearings.

Fretting and corrosion in modular-neck total hip arthroplasty femoral stems.

We reviewed 380 hip resurfacings cases between December 1999 and Dec 2012. 11 cases (2.89%) squeaked postoperatively. Mean follow-up was 88.6 months (19-130 months). Mean time to squeak was 11.3 months (3-22 months). Ten (91%) cases were male and nine (81%) cases had a Birmingham hip resurfacing. Cases were matched for age, gender, BMI and implant to three controls. Radiographs were analysed using EBRA (Einzel-Bild-Roentgen-Analysis, University of Innsbruck, Austria) software to evaluate cup orientation. There was no significant difference between the mean inclination angle of the cups (p = 0.26) or the mean anteversion angle (p = 0.29). There was no difference in serum cobalt (p = 0.20) or serum chromium (p = 0.45) levels at latest follow-up. Three of the 11 (27.3%) cases had revision surgery at a mean follow-up of 101 months (72-117 months). Squeaking was not influenced by patient demographic parameters and resolved in all cases that did not undergo revision surgery. Males with a resurfacing head size <50 mm had significantly increased odds of squeaking when compared to controls (odds ratio = 26.6; 95% CI = 1.2-573.3; p<0.05). Based on our findings, we do not recommend that squeaking on its own should be an indication for revision of hip resurfacing components.

Factors affecting squeaking in metal on metal hip resurfacings.

1420 primary cementless THRs with a minimum follow-up of 10-years were stratified according to BMI: non-obese (BMI<30kg/m(2)) and obese (BMI≥30kg/m(2)). Median age at surgery was younger in obese patients (P<0.001). We case-matched 82 THRs in obese patients with 162 THRs in non-obese patients. No difference between groups was found in improvement in HHS (P=0.668), satisfaction with surgery (P=0.644), range of movement, prosthesis orientation, or radiological loosening. The obese cohort was further separated into those with a BMI below and above 35. No difference was found between groups in improvement in HHS, satisfaction with surgery, component orientation, or radiological loosening. There was no difference in the incidence of post-operative complications between obese and non-obese patients. After 10-years, the results of THR are not compromised by obesity.

The effect of obesity on the clinical, functional and radiological outcome of cementless total hip replacement: a case-matched study with a minimum 10-year follow-up.

The aim of this study is to describe the influence of sitting and standing posture on sagittal pelvic inclination in total hip replacement patients to assist with correct acetabular component positioning.

The kinematic relationship between sitting and standing posture and pelvic inclination and its significance to cup positioning in total hip arthroplasty.

Metal-on-metal (MoM) hip resurfacings have been associated with the potential development of metallic debris and its associated pathology. Serum cobalt and chromium levels are a reliable surrogate marker of wear rates in MoM bearings. The aim of the study was to examine the trend in serum metal ion levels in the initial 2-year post-operative period following implantation of the minimally invasive total conservative hip MoM hip resurfacing and to determine whether head size, acetabular component orientation, clinical outcome scores or post-operative range of movement would affect these levels.

Two-year serum metal ion levels in minimally invasive total conservative hip resurfacing: preliminary results of a prospective study.

We analyzed the results of 206 consecutive total hip arthroplasties performed using large diameter ceramic-on-ceramic bearings. At an average follow-up of 28months, the mean Harris Hip Score improved from 54 to 92. Fifteen (7.3%) hips were noted to squeak. There was no significant difference between silent and squeaking hips with regards to age, weight, height, BMI, range of movement, femoral head diameter, leg length, and offset or center of rotation. No correlation was present between incidence of squeaking and increasing cup inclination and anteversion. 5.2% of cups orientated within Lewinnek's safe zone squeaked. No hips required revision for squeaking. While large diameter ceramic bearings may produce squeaking, our early results of surgery using large head ceramic bearings are encouraging. However, long-term follow-up is required.

Squeaking in large diameter ceramic-on-ceramic bearings in total hip arthroplasty.

Modular hip implants allows for the adjustment of leg length, offset, and the ability to remove the head for acetabular exposure during primary and revision surgery. The design of the Morse taper facilitates the intimate contact of the conical trunnion of the femoral stem (male component), with the conical bore of the femoral head (female component). Orthopaedic trunnion tapers are not standardized and vary in length, taper angle, and base dimension. Variations in the design and surface characteristics of the trunnion, will directly reflect on the interface at the taper junction and can influence the likelihood of subsequent wear, corrosion and longevity of the implant. The effect of surface topography of trunnions on commercially available hip stems has not yet been considered as a possible contributing factor in the corrosion observed at taper junctions. In this study we analyzed the surface topography and surface roughness of randomly selected commercially available femoral hip stem trunnions to obtain a greater insight into their surface characteristics.

Variations in the trunnion surface topography between different commercially available hip replacement stems.

Squeaking is a well-recognized complication for hard-on-hard bearings. The nature of squeaking is not yet completely understood however it is considered a multifactorial phenomenon. Patient, implant, and surgical factors play a role in squeaking. It is believed that mechanisms damaging the fluid film lubrication in which these bearings function optimally have a critical role. Such mechanisms include edge loading, stripe wear, impingement, third body particles and ceramic fracture. The resonance of metallic parts can produce noise in the human audible range hence the implant metallurgic composition and design may play a role. Implant positioning can facilitate impingement and edge loading enhancing the occurrence of squeaking. The recent introduction of large heads (> 36 mm) 4(th) generation ceramic-on-ceramic bearing may accentuate the conditions facilitating noise formation; however the current literature is insufficient. Clinically, squeaking may manifest in extreme hip positions or during normal gait cycle however it is rarely associated with pain. Evaluations of patients with squeaking include clinical and radiographic assessments. Computer tomography is recommended as it can better reveal ceramic breakage and implant malposition. The treatments for most squeaking patients include reassurance and activity modification. However for some, noise can be a problem, requiring further surgical intervention. In the occurrence of ceramic fracture, implant failure, extreme components malposition, instability and impingement, surgery should be advised. This review will aim to discuss the current literature regarding squeaking.

Article	Year
Fretting and corrosion in modular-neck total hip arthroplasty femoral stems. The Journal of bone and joint surgery. American volume\| PubMed ID: 24647505	2014
Factors affecting squeaking in metal on metal hip resurfacings. Hip international : the journal of clinical and experimental research on hip pathology and therapy\| PubMed ID: 24817393	2014
The effect of obesity on the clinical, functional and radiological outcome of cementless total hip replacement: a case-matched study with a minimum 10-year follow-up. The Journal of arthroplasty\| PubMed ID: 24890992	2014
The kinematic relationship between sitting and standing posture and pelvic inclination and its significance to cup positioning in total hip arthroplasty. International orthopaedics\| PubMed ID: 25132150	2015
Two-year serum metal ion levels in minimally invasive total conservative hip resurfacing: preliminary results of a prospective study. ANZ journal of surgery\| PubMed ID: 25288230	2015
Squeaking in large diameter ceramic-on-ceramic bearings in total hip arthroplasty. The Journal of arthroplasty\| PubMed ID: 25304938	2015
Variations in the trunnion surface topography between different commercially available hip replacement stems. Journal of orthopaedic research : official publication of the Orthopaedic Research Society\| PubMed ID: 25319315	2015
Review on squeaking hips. World journal of orthopedics\| PubMed ID: 26601063	2015

Selin Munir

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