Codirenzi Anastasia M, Lanting Brent A, Teeter Matthew G
School of Biomedical Engineering, Western University, London, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
J Arthroplasty. 2023 Feb;38(2):376-382. doi: 10.1016/j.arth.2022.08.023. Epub 2022 Sep 7.
Corrosion at the modular head-neck taper interface of total and hemiarthroplasty hip implants (trunnionosis) is a cause of implant failure and thus a clinical concern. Patient and device factors contributing to the occurrence of trunnionosis have been investigated in prior implant retrieval studies but generally with limited sample sizes and a narrow range of models. The purpose of the present investigation was to determine which patient and device factors were associated with corrosion damage on the femoral stem taper across a large collection of different implant models retrieved following revision hip arthroplasty.
A retrieval study of 664 hip arthroplasty modular stem components was performed. Patient and device information was collected. Trunnions were imaged under digital microscopy and scored for corrosion damage using a scaling system. Damage was related to patient and device factors using regression analyses.
Greater duration of implantation (P = .005) and larger head size (P < .001) were associated with an elevated corrosion class. Older age at index surgery (P = .035), stainless steel stem material (P = .022), indication for revision as bone or periprosthetic fracture (P = .017), and infection (P = .018) and certain larger taper geometries were associated with a decreased corrosion class.
Factors identified as contributing to a higher or lower risk of more severe corrosion are consistent with most prior smaller retrieval studies. Surgeons should be aware of these risk factors when selecting implants for their patients and when diagnosing trunnionosis in symptomatic hip arthroplasty patients.
全髋关节置换和半髋关节置换植入物的模块化头颈锥度界面处的腐蚀（轴颈病变）是植入物失败的一个原因，因此是一个临床关注点。在先前的植入物取出研究中已经调查了导致轴颈病变发生的患者和器械因素，但样本量通常有限且模型范围狭窄。本研究的目的是确定在大量翻修髋关节置换术后取出的不同植入物模型中，哪些患者和器械因素与股骨干锥度上的腐蚀损伤相关。
对664个髋关节置换模块化柄部件进行了取出研究。收集了患者和器械信息。在数字显微镜下对轴颈进行成像，并使用评分系统对腐蚀损伤进行评分。使用回归分析将损伤与患者和器械因素相关联。
植入时间更长（P = .005）和股骨头尺寸更大（P < .001）与腐蚀等级升高相关。初次手术时年龄较大（P = .035）、不锈钢柄材料（P = .022）、翻修指征为骨或假体周围骨折（P = .017）、感染（P = .018）以及某些较大的锥度几何形状与腐蚀等级降低相关。
确定为导致更严重腐蚀风险较高或较低的因素与大多数先前规模较小的取出研究一致。外科医生在为患者选择植入物以及对有症状的髋关节置换患者诊断轴颈病变时应了解这些风险因素。
