Evidence based recommendations for reducing head-neck taper connection fretting corrosion in hip replacement prostheses
- Wight C. M., Lanting B., Schemitsch E. H.
- Hip Int. 2017 Nov 21;27(6):523-531. doi: 10.5301/hipint.5000545.
- Level of Evidence
- Not indicated
The authors performed a systematic literature review with the aim to collect all the available knowledge about fretting corrosion occurrence in hip arthroplasty, in order to offer recommendations to reduce its incidence. “Taper”, “trunnion”, “cone”, “head-neck junction”, “hip” were the terms used for the search algorithm in Pubmed, MEDLINE and EMBASE. The inclusion criteria were total hip replacement, full text available, publication in English, investigates prosthesis design/implant manufacture and/or surgical factors and investigates fretting corrosion and/or material loss. Patient metal ions levels and Adverse Reactions to Metal Debris (ARMD) were the outcome measures of clinical studies. The qualitative and semi-quantitative visual assessment, wear volume and surface profile were the outcome measured for retrieval studies. These were the same for the in-vitro studies with the addition of the electrochemical activity.
The initial search resulted in 1,224 articles, but 91 remained for the analysis.
Avoid use of high lateral off-set femoral heads, retaining macroscopically undamaged stems at revision, paying particular attention to fretting corrosion’s progression with time and risk with heavy or more active patients resulted to be the general recommendations to mitigate fretting corrosion.
Small head sizes, avoiding cast alloy femoral heads and avoiding stem with low flexural rigidity are recommended for the use of metal heads.
- Publication bias.
- Only publications in English searched.
- Fretting corrosion is a multifactorial problem.
- Prostheses selection is critical and has to be carefully considered.
- Use of ceramic head as an alternative to metal is strongly supported, in order to mitigate the occurrence of fretting corrosion.
- According to the authors, there is fair evidence to prefer the use of ceramic or ceramicised metal heads rather than metal heads to mitigate the risk fretting corrosion.