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Adverse clinical outcomes in a primary modular neck/stem system.

Camilo Restrepo1, David Ross1, Santiago Restrepo1

  • 1Investigation performed at the Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.

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|June 30, 2014
PubMed
Summary

Recalled neck modular stems often show corrosion. While serum cobalt levels may only slightly increase, many patients experience symptoms or abnormal imaging, with 13% requiring revision surgery for corrosion.

Keywords:
chromiumcobaltcomplicationsmetal corrosiontotal hip arthroplasty

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Medical Device Corrosion

Background:

  • Corrosion of recalled neck modular stems is a significant concern in hip arthroplasty.
  • Understanding the clinical and biological impact of this corrosion is crucial for patient management.

Purpose of the Study:

  • To evaluate the clinical outcomes, serum cobalt levels, and imaging findings in patients with recalled neck modular stems.
  • To determine the incidence of revision surgery due to corrosion in this cohort.

Main Methods:

  • Retrospective review of 215 recalled neck modular stems.
  • Clinical assessment, serum cobalt level analysis, and imaging studies (e.g., X-ray, MRI) were performed.
  • Follow-up data, including revision surgery rates, were collected for 195 hips over 2 years.

Main Results:

  • 56% of hips were asymptomatic, while 26% reported groin pain and 17% had other symptoms.
  • Serum cobalt levels were comparable between symptomatic and asymptomatic patients.
  • Abnormal imaging findings were significantly more common in symptomatic hips (46%) than asymptomatic hips (11%).
  • 13% of hips (26 hips) required or were scheduled for revision surgery due to corrosion, confirmed in all cases.

Conclusions:

  • Recalled neck modular stems frequently exhibit corrosion, leading to clinical symptoms and abnormal imaging.
  • Serum cobalt levels alone may not accurately predict symptomatic corrosion.
  • A significant percentage of patients require revision surgery, highlighting the importance of monitoring and early intervention.