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Surveillance of Dual-Mobility Hip Systems: Damage Mode and Clinical Data Analysis
Conner D Ahlgren1, Rami S Beydoun1, Michael J Maxwell1
1Department of Orthopedic Surgery, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan.
Insights
Dual-mobility (DM) total hip arthroplasty (THA) components show mild-to-moderate fretting and corrosion in vivo. Longer implantation times correlate with femoral head taper corrosion, while infection amplifies trunnion corrosion.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Implant Retrieval Analysis
Background:
- Hip instability is a common reason for revision total hip arthroplasty (THA).
- Dual-mobility (DM) systems are increasingly used to improve THA stability.
- Understanding in vivo implant damage in DM THA is crucial.
Purpose of the Study:
- To characterize in vivo damage modes in retrieved dual-mobility total hip arthroplasty components.
- To correlate implant damage with clinical data, including duration of implantation and reason for revision.
Main Methods:
- Analysis of 51 retrieved DM THA systems.
- Macroscopic examination and microscopic grading of fretting corrosion at the trunnion interface.
- Collection and review of clinical data from patient medical records.
Main Results:
- Revision indications included mechanical complications (27%), infection (22%), and dislocation (16%).
- Femoral head taper corrosion correlated with longer implantation duration (average 12 months).
- Screw-liner corrosion was associated with increased acetabular and femoral osteolysis.
Conclusions:
- DM THA components exhibit in vivo damage, primarily mild-to-moderate fretting and corrosion, after short-to-midterm implantation.
- Femoral head taper corrosion increases with implantation time; trunnion corrosion is amplified by infection.
- Screw-liner corrosion may contribute to osteolysis, warranting further investigation.
Background:
Hip instability following total hip arthroplasty (THA) is among the most common indications for revision surgery. The implantation of dual-mobility (DM) systems, designed to improve stability, continues to rise, and thus, characterizing in vivo implant damage modes is paramount.
Methods:
Under an implant retrieval protocol, 51 DM THA systems were analyzed. Each component was examined for macroscopic damage and microscopically graded for fretting corrosion at the trunnion interface. Clinically relevant data were collected from medical records.
Results:
Revision indications included mechanical complications (n = 15, 27%), infection (n = 12, 22%), and dislocation (n = 9, 16%). The average duration of implantation was 12 months, which significantly correlated with summed femoral head taper corrosion (P = 0.044). Average summed fretting and corrosion scores were 2.9 and 3.0 for heads (two regions, 2 to 8 summed scores possible) and 7.6 and 7.1 for trunnions (four quadrants, 4 to 16 summed scores possible), respectively. Scratching (n = 26, 65.4%) was the most common damage mode on articular surfaces of acetabular cups, burnishing (n = 29, 55.2%) on metal liners, and edge deformation (n = 22, 45.5%) on polyethylene liners. Screw-liner corrosion was noted on 10.3% (n = 3) of available acetabular liners; an increased incidence of acetabular and femoral osteolysis was noted when this damage mode was present (P = 0.019 and P = 0.022, respectively).
Conclusions:
This series demonstrated in vivo damage of DM THA components following short-term-to-midterm (zero to five years) implantation, with overall mild-to-moderate fretting and corrosion scores. Femoral head taper corrosion correlated with longer implantation, and amplified trunnion corrosion was observed in the setting of infection. Screw-liner corrosion may be related to acetabular and femoral osteolysis. This study indicates trends that merit further evaluation.
