Morlock Michael, Bünte Dennis, Gührs Julian, Bishop Nicholas
Institute of Biomechanics, TUHH Hamburg University of Technology, Denickestrasse 15, 21073 Hamburg, Germany.
HSS J. 2017 Feb;13(1):42-49. doi: 10.1007/s11420-016-9526-4. Epub 2016 Sep 20.
The modular head taper junction has contributed to the success of total hip arthroplasty (THA) greatly. Taper corrosion and wear problems reported for large and extra-large metal-on-metal bearings as well as for bi-modular THA stems have cast doubt on the benefit of the taper interface. Presently, corrosion problems are being reported for nearly all kinds of artificial hip joints incorporating metal heads, questioning taper connections in general.
QUESTIONS/PURPOSES: This study aimed to review the mechanical and electrochemical relationships that may lead to taper corrosion, which have been reported more commonly in recent literature, and to also review the contribution of patient characteristics and surgical techniques involved in taper assembly that may contribute to the problem.
The search criteria "(corrosion) AND (hip arthroplasty) AND (taper OR trunnion)" and "(hip arthroplasty) AND ((pseudotumor) OR (pseudo-tumor))" in PubMed and the JAAOS were used for the literature search. In addition, the arthroplasty registers were considered.
Most studies acknowledge the multifactorial nature of the problem but concentrate their analysis on taper and implant design aspects, since this is the only factor that can be easily quantified. The sometimes conflicting results in the literature could be due to the fact that the other two decisive factors are not sufficiently considered: the loading situation in the patient and the assembly situation by the surgeon. All three factors together determine the fate of a taper junction in THA. There is no single reason as a main cause for taper corrosion. The combined "outcome" of these three factors has to be in a "safe range" to achieve a successful long-term taper fixation.
No, this is not the beginning of an epidemic. It is rather the consequence of disregarding known mechanical and electrochemical relationships, which in combination have recently caused a more frequent occurrence-and mainly reporting-of corrosion issues.
模块化头部锥度连接对全髋关节置换术（THA）的成功起到了极大的推动作用。针对大型和超大尺寸金属对金属轴承以及双模块化THA柄所报道的锥度腐蚀和磨损问题，引发了人们对锥度界面益处的质疑。目前，几乎所有含金属头的人工髋关节都出现了腐蚀问题，这使得人们对锥度连接普遍产生了质疑。
问题/目的：本研究旨在回顾近期文献中更常见报道的、可能导致锥度腐蚀的力学和电化学关系，并回顾患者特征以及锥度组装过程中涉及的手术技术对该问题可能产生的影响。
在PubMed和《美国骨与关节外科杂志》（JAAOS）中使用检索词“（腐蚀）AND（髋关节置换术）AND（锥度或耳轴）”以及“（髋关节置换术）AND（（假肿瘤）OR（假瘤））”进行文献检索。此外，还参考了关节置换登记资料。
大多数研究都认识到该问题具有多因素性质，但将分析集中在锥度和植入物设计方面，因为这是唯一能够轻松量化的因素。文献中有时相互矛盾的结果可能是由于另外两个决定性因素未得到充分考虑：患者体内的负荷情况以及外科医生的组装情况。这三个因素共同决定了THA中锥度连接的命运。不存在单一的主要原因导致锥度腐蚀。这三个因素的综合“结果”必须处于“安全范围”内，才能实现长期成功的锥度固定。
不，这并非一场流行趋势的开端。这更像是忽视已知的力学和电化学关系所导致的结果，这些关系最近共同导致了腐蚀问题更频繁地出现——且主要是被报道出来。
