Elsevier

The Journal of Arthroplasty

Volume 32, Issue 12, December 2017, Pages 3782-3795
The Journal of Arthroplasty

Basic Science
Microstructure and Surface Damage in Retrieved Metal-on-Metal Hip Arthroplasties

https://doi.org/10.1016/j.arth.2017.06.044Get rights and content

Abstract

Background

Besides promising results of metal-on-metal (MOM) hip arthroplasty (HA), frequent failures have been reported even in the short term. Many host, surgical, design, metallurgical, and processing factors have been evoked in the base of these events. We have tried to characterize and to evaluate metallurgical and processing features present in this type of implants.

Methods

The acetabular and femoral components of 20 MOM HAs collected from a multicenter retrieval program were examined. All the specimens were inspected with naked eye, with confocal microscopy and vertical scanning interferometry, scanning electron microscopy, back-scattered electron imaging, and energy-dispersive X-ray spectroscopy, in 25 zones of each articular component.

Results

Gas pores, shrinkage voids and holes of detached carbides, carbides on surface, embedded particles, scratches and marks of wear, surface discoloration, surface deposits, and tribochemical reaction layers were widely dispersed through a substantial percentage of the total bearing surface in all the implanted components. Surface cup and head voids, and cup scratches showed significant correlation with the clearance of pair. A higher surface damage of the cup and head was observed mainly in the low clearance prostheses. There was no other significant correlation or difference in the incidence and importance of any of these defects between resurfacing hip arthroplasties and total hip arthroplasties, or according to the pair diameter.

Conclusion

Some metallurgical features and surface damage were significantly present in the retrieved implants of MoM HAs. It would be desirable to improve the structure and metallurgical characteristics of these implants to avoid those effects and optimize their performance.

Section snippets

Materials and Methods

The implants included in this study were obtained from 49 withdrawal MoM HAs, received in our laboratory during the year 2013 within a multicenter retrieval program approved by an independent institutional ethics committee, and retained according to the following inclusion criteria: (1) failed primary arthroplasty; (2) contemporary designs currently in use; (3) having the 2 articular components of each HA; (4) complete demographic and preoperative, intraoperative, and postoperative clinical,

Results

All the following features were observed in 100% of the studied specimens in the magnitudes expressed in Table 2.

Macroscopically, layers of discoloration (Fig. 1A) and scrapes (Fig. 1B) were observed in the articular surface of the retrieved components, and the confocal microscopy revealed grooves and scratches, up to 200 μm wide and 3-5 mm long, forming an intricate network widely distributed over the articular surface (Fig. 1C and D). The Rt of the highly grooved areas was up to 3 μm

Discussion

MoM has been used in HAs for young patients, with clinical results and survivorship very dependent on the implant employed (Table 3) [1], [3], [4], [36], [74], [75], [76], [77]. These differences being multifactorial, the metallurgy and processing of these devices could be one of the issues influencing their performance [5], [39], [59], [78].

We have studied in depth, from the metallurgical standpoint, a series of retrieved MoM HAs of the current generation without extrinsic reasons to

References (90)

  • B. Patel et al.

    Cobalt-based orthopaedic alloys: relationship between forming route, microstructure and tribological performance

    Maters Sci Eng C

    (2012)
  • C. Klapperich et al.

    Failure of a metal-on-metal total hip arthroplasty from progressive osteolysis

    J Arthroplasty

    (1999)
  • J.K. Lord et al.

    Volumetric wear assessment of failed metal-on-metal hip resurfacing prostheses

    Wear

    (2011)
  • W.C. Witzleb et al.

    In vivo wear rate of the Birmingham hip resurfacing arthroplasty. A review of 10 retrieved components

    J Arthroplasty

    (2009)
  • W. van der Weegen et al.

    Treatment of pseudotumors after metal-on-metal hip resurfacing based on magnetic resonance imaging, metal ion levels and symptoms

    J Arthroplasty

    (2014)
  • J.V. Giacchi et al.

    Microstructural characterization of as-cast biocompatible Co-Cr-Mo alloys

    Mater Charact

    (2011)
  • M. Alvarez-Vera et al.

    Failure analysis of Co-Cr hip resurfacing prosthesis during solidification

    Case Stud Eng Fail Anal

    (2013)
  • A. Chiba et al.

    Pin-on-disk wear behavior in a like-on-like configuration in a biological environment of high carbon cast and low carbon forged Co-29Cr-6Mo alloys

    Acta Mater

    (2007)
  • F. Hannemann et al.

    European multidisciplinary consensus statement on the use and monitoring of metal-on-metal bearings for total hip replacement and hip resurfacing

    Orthop Traumatol Surg Res

    (2013)
  • H.C. Amstutz et al.

    Resurfacing THA for patients younger than 50 year: results of 2- to 9-year followup

    Clin Orthop Relat Res

    (2007)

  • Metal-on-metal bearing surface total conventional hip arthroplasty. Supplementary Report

  • National Joint Registry for England, Wales and Northern Ireland: 12th Annual Report

  • J. Daniel et al.

    Ten-year results of a double-heat-treated metal-on-metal hip resurfacing

    J Bone Joint Surg Br

    (2010)
  • W. van der Weegen et al.

    Survival of metal-on-metal hip resurfacing arthroplasty: a systematic review of the literature

    J Bone Joint Surg Br

    (2011)
  • M. Klein et al.

    Complications after hip resurfacing using the ASR prosthesis in patients with osteoarthritis

    Z Orthop Unfall

    (2008)
  • D.J. Langton et al.

    Accelerating failure rate of the ASR total hip replacement

    J Bone Joint Surg Br

    (2011)
  • D.J. Langton et al.

    Adverse reaction to metal debris following hip resurfacing. The influence of component type, orientation and volumetric wear

    J Bone Joint Surg Br

    (2011)
  • A. Reito et al.

    High prevalence of adverse reactions to metal debris in small-head ASR™ hips

    Clin Orthop Relat Res

    (2013)
  • F.S. Haddad et al.

    Metal-on metal bearings: the evidence so far

    J Bone Joint Surg Br

    (2011)
  • S.S. Jameson et al.

    Independent predictors of revision following metal-on-metal hip resurfacing. A retrospective cohort study using national joint registry data

    J Bone Joint Surg Br

    (2012)
  • M. Khan et al.

    The exercise-related rise in plasma cobalt levels after metal-on-metal hip resurfacing arthroplasty

    J Bone Joint Surg Br

    (2008)
  • D.W. Murray et al.

    The ten-year survival of Birmingham hip resurfacing. An independent series

    J Bone Joint Surg Br

    (2012)
  • G.H. Prosser et al.

    Outcome of primary resurfacing hip replacement: evaluation of risk factors for early revision. 12,093 replacements from the Australian Joint Registry

    Acta Orthop

    (2010)
  • P.A. Vendittoli et al.

    Chromium and cobalt ion release following the Durom high carbon content, forged metal-on-metal surface replacement of the hip

    J Bone Joint Surg Br

    (2007)
  • E.J. Yue et al.

    Hip resurfacing arthroplasty. Risk factors for failure over 25 years

    Clin Orthop Relat Res

    (2009)
  • H.C. Amstutz et al.

    Socket position determines resurfacing 10-year survivorship

    Clin Orthop Relat Res

    (2012)
  • M. Burbano et al.

    Surface characterization of retrieved metal-on-metal total hip implants from patients with adverse reaction to metal debris

    Materials

    (2014)
  • R. De Haan et al.

    Revision of metal-on-metal resurfacing arthroplasty of the hip. The influence of malpositioning of the components

    J Bone Joint Surg Br

    (2008)
  • R. De Haan et al.

    Correlation between inclination of the acetabular component and metal ion levels in metal-on-metal hip resurfacing replacement

    J Bone Joint Surg Br

    (2008)
  • A.J. Hart et al.

    Understanding why metal-on-metal hip arthroplasties fail. A comparison between patients with well-functioning and revised Birmingham Hip Resurfacing arthroplasties

    J Bone Joint Surg Am

    (2012)
  • A.J. Hart et al.

    Insufficient acetabular version increases blood metal ion levels after metal-on-metal hip resurfacing

    Clin Orthop Relat Res

    (2011)
  • D.J. Langton et al.

    Blood metal ion concentrations after hip resurfacing arthroplasty: a comparative study of articular surface replacement and Birmingham Hip Resurfacing arthroplasties

    J Bone Joint Surg Br

    (2009)
  • G. Mabilleau et al.

    Metal-on-metal hip resurfacing arthroplasty: a review of periprosthetic biological reactions

    Acta Orthop

    (2008)
  • A.J. Hart et al.

    Which factors determine the wear rate of large-diameter metal-on-metal hip replacements? Multivariate analysis of two hundred and seventy-six components

    J Bone Joint Surg Am

    (2013)
  • Y.M. Kwon et al.

    Analysis of wear of retrieved metal-on-metal hip resurfacing implants revised due to pseudotumours

    J Bone Joint Surg Br

    (2010)

    • This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

    One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.06.044.

    This work was performed in the Departamento de Ciencia de los Materiales, ETSEIB, Universidad Politécnica de Cataluña, Barcelona, Spain.

    View full text
    © 2017 Elsevier Inc. All rights reserved.