Large versus small femoral heads in metal-on-metal total hip arthroplasty

doi:10.1016/j.arth.2004.09.006

The Journal of Arthroplasty

Volume 19, Issue 8, Supplement, December 2004, Pages 41-44

https://doi.org/10.1016/j.arth.2004.09.006 Get rights and content

Abstract

The recent resurgence of metal-on-metal total hip arthroplasty has afforded the surgeon new options in femoral head diameters that were not previously available. Reduction in the risk for dislocation and potential improvements in articular wear are the obvious advantages of large-diameter femoral heads. Total hips with larger-diameter femoral heads are more resistant to dislocation. The clinical experience with 616 38 mm diameter femoral heads showed no dislocations within the first 3 months after surgery, compared with 2.5% of 78 patients receiving 28 mm diameter femoral heads with otherwise identical components. Use of larger-diameter femoral heads appears to have the potential to substantially reduce the early risk of dislocation of the prosthetic hip arthroplasty.

Section snippets

Materials and methods

The authors’ experience with MOM THA includes 28 and 38 mm diameter femoral heads using the Bimetric® or Mallory-Head® femoral stems (Biomet, Warsaw, IN). Initial experience with the 28 mm diameter femoral head was obtained as part of the FDA IDE study on the implant [16]. This study used modular cobalt-chrome-molybdenum (CoCr) inserts in modular titanium alloy hemispheric shells with titanium plasma spray coating (Biomet). Subsequent experience with a 38 mm, nonmodular acetabular implant

Results

The range of motion without impingement of the 2 designs is 126°, and 154°, respectively, for the 28 and 38 mm components used in this series (data on file, Biomet). Seventy-eight patients received 28 mm diameter femoral heads, while 616 patients received 38 mm diameter heads. The demographics and type of surgical approach are shown in Table 1. Dislocation incidence was recorded for both groups during the first 3 months after surgery; all patients in both groups have been followed more than 3

Discussion

Larger diameter MOM femoral heads present the possibility of reduced risk of dislocation, with reduced wear of the articular couple. Whereas alternate articular couples such as ceramic-on-ceramic offer reduction in wear, the mechanical characteristics of existing ceramic materials and requirement for bone-implant fixation with modular porous coated metal shells will not allow the use of large-diameter femoral heads. The use of large-diameter femoral heads with modular highly cross-linked

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A retrospective review was performed on all patients who underwent primary THA at our center with the M²a-Magnum system (Zimmer Biomet, Warsaw, IN). Of 829 patients (956 hips) identified, 754 patients (869 hips) met inclusion criteria of signed research consent, minimum 2-year follow-up, and/or any revision surgery.
Mean follow-up was 11.0 years (range 2-16; ±3.5). Mean cup angle of inclination was 42.8° (range 24°-70°, ±6.3°), with 88.0% reconstructed within the 40° ± 10° safe zone. There were 64 revisions (7.36%): 7 (0.81%) septic and 57 (6.56%) aseptic. Of those, 32 (3.68%) were adverse reactions to metal debris. Kaplan-Meier survival free of revision for all causes was 88.6% at 16 years (95% confidence interval 86.8-90.4). Univariate analysis of risk factors for all-cause, aseptic, and adverse reaction to metal debris revision found no relationship with female gender, age ≥65 years, body mass index >30 kg/m², higher activity level, or inclination angle outlier.
The results of this study demonstrate a more favorable mid-term to long-term survivorship with this specific MoM implant compared to other designs. Although our institution no longer performs MoM THA, further investigation into differences in MoM implant designs is warranted.
Predictive Factors for Revision and Survivorship Analysis of a Prevalent 36-mm Metal-on-Metal Total Hip Replacement System: A Large Single-Center Retrospective Cohort Study
2021, Journal of Arthroplasty
To our knowledge, this is the largest single-center cohort of the 36-mm Corail-Pinnacle metal-on-metal total hip replacements system, aiming to determine 10-year survivorship and identify predictors of revision. We further assessed year of implantation given reports of manufacturing variations affecting shells made after 2006 predisposing these components to increasing wear.
All Corail-Pinnacle 36-mm metal-on-metal hips implanted in a single center (2005-2012). The effect of patient and implant-related variables, and year of implantation on revision risk was assessed using Kaplan-Meier, Cox regression, and interrupted time series analysis.
In total, 1212 metal-on-metal total hip replacements were implanted with a 10-year survival rate of 83.4% (95% confidence interval [CI] = 81.3-85.5). Mean follow-up duration was 7.3 years with 61% of patients reaching a minimum of 7 years of follow-up. One hundred nineteen patients required revision surgery (9.8%). Univariate analysis identified female gender (hazard ratio [HR] = 1.608, CI = 1.093-2.364, P = .016), age at implantation (HR = 0.982, CI = 0.968-0.997, P = .019), smaller 50-mm to 54-mm cup diameter (HR = 1.527, CI = 1.026-2.274, P = .037), and high-offset stems (HR = 2.573, CI = 1.619-4.089, P < .001) as predictors of revision. Multivariate modeling confirmed female gender and high-offset stems as significant predictors of revision. For components implanted after 2007, the number of revisions showed no statistically significant step increase compared to pre-2007 implantation.
We observed a high 10-year failure rate (16.6%) with this implant, mostly due to adverse reaction to metal debris. Female gender and high femoral offset stems were significant predictors for all-cause revision. Year of implantation was not significantly associated with an increasing number of revisions from 2007 onwards, although further studies to validate the impact of manufacturing discrepancies are recommended.
Pinnacle Ultamet metal-on-metal total hip arthroplasty survivorship: average 10-year follow-up
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It is unclear whether a connection exists between femoral head size, offset, neck length, and cup abduction angles, and rate of revision in metal-on-metal (MoM) total hip arthroplasty (THA) implant systems.
A retrospective review of MoM THA completed by a single surgeon with a single implant between 2003 and 2008 was conducted. Patient demographics, implant data, radiographs, and revision details were collected at follow-up. Incidence rates for revision and osteolysis were calculated in regard to the femoral head size, stem offset, neck length, and cup abduction angles.
Six hundred and ninety two THAs were identified, with 79% of patients returning for a median follow-up of 10.3 years (interquartile range = 6.0-12.3). The median time to revision was 7.5 years (interquartile range = 5.3-9.9) among 27 total revision surgeries. The overall incidence rate of revision was 5.4 revisions per 1000 person-years, 3.0 revisions per 1000 person-years for adverse local tissue reaction. Hips with a cup abduction angle of ≤40° had revisions at nearly twice the rate of those with an angle of 41°-50° (incidence rate ratio = 1.98, 95% confidence interval: 0.92, 4.29). Hips with a 9 mm neck length had an increased rate of revision (incidence rate ratio = 5.94, 95% confidence interval: 1.33, 26.55) relative to those with a neck length of 0 mm. Rates of osteolysis were similar between implants of different head sizes, neck lengths and cup abduction angles.
MoM implant systems with longer necks and smaller cup abduction angles may lead to increased need for revision. Results from this study suggest a need for closer long-term follow-up of MoM THA systems.
Influence of flexural rigidity on micromotion at the head-stem taper interface of modular hip prostheses
2019, Medical Engineering and Physics
Fretting corrosion as one reason for failure of modular hip prostheses has been associated with micromotion at the head taper junction. Historically the taper diameter was reduced to improve the range of motion of the hip joint. In combination with other developments, this was accompanied by increased observations of taper fretting, possibly due to the reduced flexural rigidity of smaller tapers. The aim of the study was to investigate how the flexural rigidity of tapers influences the amount of micromotion at the head taper junction.
Three different stem and two different taper designs were manufactured. Experimental testing was performed using three different activity levels with peak loads representing walking, stair climbing and stumbling. The relative motion at the head-stem taper was measured in six degrees of freedom. Micromotion was obtained by subtraction of the elastic deformation derived from monoblock and finite element analysis.
Less rigid tapers lead to increased micromotion between the head and stem, enlarging the risk of fretting corrosion. The influence of the stem design on micromotion is secondary to taper design. Manufacturers should consider stiffer taper designs to reduce micromotion within the head taper junction.
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2018, Seminars in Arthroplasty JSES
For some patients, total hip arthroplasty (THA) continues to be complicated by postoperative instability and dislocation. The risk of dislocation is markedly higher in patients with predisposing conditions, including coexisting spinal pathology. In these patients, implant design and choice may offer added stability. Larger femoral heads, dual mobility constructs, constrained acetabular liners, and elevated acetabular liners offer enhanced stability in patients who are at risk for postoperative instability. Similarly, pre-operative templating, surgical approach, and surgical techniques such as trochanteric advancement may also influence stability. This review will discuss the evidence, advantages, and disadvantages of the various implant options and surgical techniques for enhancing stability in high risk patients after THA.
Mechanical and phase transformation behaviour of biomedical Co-Cr-Mo alloy fabricated by direct metal laser sintering
2018, Materials Science and Engineering: A
Citation Excerpt :
The use of metal-on-metal bearings in total hip arthroplasties allows deployment of large diameter femoral head (> 32 mm) components [1,2]. Such design offers greater range of motion, reduces risk of component-to-component impingement [3,4], while providing reduced articular wear. For several decades, biomedical cobalt-chrome-molybdenum (Co-Cr-Mo) alloys are employed for this application due to their favourable properties including high strength combined with excellent corrosion and wear resistance [5–7].
Biomedical cobalt-chromium-molybdenum (Co-Cr-Mo) alloys have been used in the cast or wrought form as prosthetic implant materials for more than five decades. Recently, additive manufacturing techniques are employed to produce parts directly from metal precursor powder with a composition suitable for biomedical applications. In the work present, we examine both mechanical behaviour and γ→ε phase transformation in the heat treated Co-Cr-Mo alloy fabricated via additive manufacturing route. Results suggest, that selection of appropriate heat treatment and control of martensitic transformation can significantly influence mechanical properties. The studied Co-Cr-Mo alloy can be considered as a potential material for biomedical applications.

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^☆: Benefits or funds were received in partial or total support of the research material described in this article. These benefits or support were received from Biomet, Inc., Warsaw, Indiana.

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Large versus small femoral heads in metal-on-metal total hip arthroplasty☆

Abstract

Section snippets

Materials and methods

Results

Discussion

Prognosis of total hip replacement in SwedenFollow-up of 92,675 operations performed 1978–1990

Acta Orthop Scand

The elevated-rim acetabular liner in total hip arthroplastyrelationship to postoperative dislocation

J Bone Joint Surg Am

Late dislocation after total hip arthroplasty

J Bone Joint Surg Am

The effect of acetabular cup orientations on limiting hip rotation

J Arthroplasty

Femoral anteversion and restricted range of motion in total hip prostheses

Acta Radiol

Position, orientation and component interaction in dislocation of the total hip prosthesis

Acta Radiol

Classification and treatment of dislocations of total hip arthroplasty

Clin Orthop

Range of motion studies for total hip replacementsA comparative study with a new experimental apparatus

Clin Orthop

The effect of femoral component head size on posterior dislocation of the artificial hip joint

J Bone Joint Surg Am

Relationship of femoral head and acetabular size to the prevalence of dislocation

Clin Orthop

Dislocation after total hip arthroplasty

Arch Orthop Traum Surg

Dislocations and the femoral head size in primary total hip arthroplasty

Clin Orthop