Fretting and Corrosion Damage in Taper Adapter Sleeve for Ceramic Heads: a Retrieval Study
- D.W MacDonald, A.F. Chen, G.C. Lee, G.R. Klein, M.A. Mont, S.M. Kurtz, H. Cates, M., Kraay, C.M. Rimnac, Philadelphia, Paramus, Cleveland, Knoxville, USA
- The Journal of Arthroplasty 2017. Article in press, http://dx.doi.org/10.1016/j.arth.2017.04.025
- Level of Evidence
- Level IV (Case series)
MacDonald et al. conducted a retrieval study of 37 sleeved (TI-alloy) ceramic heads (BIOLOX®OPTION). The implants were predominantly revised for instability, infection, or loosening. Implantation time was between 0 and 3.3 years. Seventeen sleeved heads were implanted during revision and 19 during primary total hip arthroplasty (THA). There were no revisions due to reactions to metal debris. All femoral stems have been made of Ti-alloy and were only revised if not well-fixed. A 4-point qualitative scoring system was used to evaluate tribo-corrosion of the sleeve and stem surfaces.
Mild to moderate tribo-corrosion (score 2-3) was observed on 92% of internal sleeve surfaces (in contact with stems), 19% of external sleeves (in contact with ceramic heads), and 78% of stems. A negligible score of 1 was observed on 8% of the internal sleeve surfaces, 81% of external sleeves, and 17% of stems. No differences between sleeves used for primary or revision surgery could be detected. Severe fretting corrosion (score 4) was observed only on one stem taper, which has been retained in situ during a previous revision surgery. The severity of tribo-corrosion on the external sleeve taper was correlated with the implantation time and sleeve length correlated with the internal sleeve surface damage. No correlation between tapers surface condition and patient or implant factors was observed.
The authors concluded that tribo-corrosion can also occur with sleeved ceramic femoral heads, but predominantly was only mild and lower than reported previously for metal-on-polyethylene bearings. They did not find a difference between the uses of sleeved ceramic heads for primary and revision surgeries. According to them sleeves are a reasonable solution for restoring the stem taper during revision surgery.
- Short implantation time
- Sample size was low and not based on power analysis
- Retrieval study represent only failed implants
- No determination of material loss
- Only Ti-alloy stems were available
- On 81% of external adapter taper surfaces (in contact with ceramic) only negligible and the rest mild to moderate tribo-corrosion
- On 92% of internal sleeve taper surfaces (in contact with stem tapers) only mild to moderate corrosion scores
- No difference in tribo-corrosion severity between primary and revision applications
- The authors support the use of sleeved ceramic heads for revision surgery
This is another study on tribo-corrosion of retrievals showing limited corrosion at the sleeve-ceramic and only mild to moderate corrosion at the stem-sleeve interface for the BIOLOX®OPTION solution. Although only observed at a short follow-up period and taking into consideration other options in a revision situation this solution seems to be a reasonable and effective choice to address the tribo-corrosion issue.