Total hip arthroplasty (THA) performed in patients aged 60 years and younger requires several decades of implant use under increased activity demands. Implant longevity and stable fixation are necessary for 30 or more years. The search for the optimal bearing combination for use in younger, high demand patients presents a challenge for orthopaedic surgeons as they consider the pros and cons of each material and interaction. A recent U.S. study of implant utilization trends that included 174 hospitals and 105,000 THA between 2001 and 2012 found that in 2012 93% of THA were cementless and 35% of THA bearings were ceramic-on-highly crosslinked polyethylene (HXLPE). Another recent article used the Nationwide Inpatient Sample from 2009 to 2012 to study bearing usage trends in 9265 primary THA in patients 30 years old or younger. The researchers observed ceramic-on-polyethylene as the most commonly bearing surface, used in 36% of patients, and which represented an increase from an earlier study of extremely young patients undergoing primary THA between 2006 to 2009, use of so-called hard-on-hard bearings decreased. Benefits of ceramic-on-HXLPE bearings are that unlike metal-on-polyethylene and metal-on-metal combinations, taperosis and adverse reactions to metal debris are non-existent. Ceramic-on-polyethylene is forgiving, it is an extremely low wear couple, it is the current presenter's bearing of choice in high demand patients, and it is a good option in the scenario of revision of failed metal-on-metal or for taperosis. Advantages to bulk ceramics are: extremely hard and scratch resistant to third body wear, not damaged by instruments and repositioning, excellent wettability, extreme low wear against itself with no known pathogenic reaction to ceramic particles, inherently stable with no oxidation or aging effect, no corrosion, safe in terms of metal ion release, no known risk of hypersensitivity or allergy, and no concerns about biological reaction. Biolox® (Ceramtec AG; Plochingen, Germany) ceramics have been available since 1974, with fourth generation Biolox® Delta introduced in 2003. Extensive clinical experience includes over 1630 published studies with over 12 million Biolox® components implanted with almost every available hip system. Two recent meta-analyses studies of randomised controlled trials comparing ceramic-on-ceramic to ceramic-on-polyethylene found significantly higher linear wear in ceramic-on-polyethylene but higher incidences of noise and fracture in ceramic-on-ceramic THA. There were no differences in revision, function, dislocation, osteolysis or loosening. A recent meta-analysis review of randomised controlled trials reporting survivorship of ceramic-on-ceramic, ceramic-on-HXLPE, and metal-on-HXLPE found no difference among bearing surfaces in risk of revision after primary THA in patients younger than 65. Risk ratio for revision was 0.65 (p=0.50) between ceramic-on-ceramic and ceramic-on-HXLPE, and 0.40 (p=0.34) between ceramic-on-ceramic and metal-on-HXLPE. A recent study of ceramic-on-HXLPE bearings for 130 cementless THA in 119 patients younger than 50 years at mean follow-up of 8.3 years (range, 7–9) reported a mean post-operative Harris hip score of 94, UCLA activity score of 8.1, no acetabular revisions, no osteolysis, no head or liner fracture, and 0.022 ± 0.003 mean annual penetration rate of the femoral head. While longer follow-up is necessary, ceramic-on-HXLPE bearings are an attractive option in younger, high demand patients undergoing primary THA

Aims

We present a case series of ten metal-on-polyethylene total hip arthroplasties (MoP THAs) with delayed dislocation associated with unrecognised adverse local tissue reaction due to corrosion at the trunnion and pseudotumour formation.

The October 2015 Hip & Pelvis Roundup. 360 . looks at: Smoking and complications in arthroplasty; Smoking cessation beneficial in arthroplasty; Intermediate care and arthroplasty; Do we still need cell salvage?; Femoroacetabular impingement in the Japanese population; Trunnionosis or taperosis and geometry; Decontamination for staphylococcus aureus works!; Policeman or opportunity? Quality improvement with registries; Death rates higher in readmission to other hospitals

Tribocorrosion at the head–neck taper interface – so-called ‘taperosis’ – may be a source of metal ions and particulate debris in metal-on-polyethylene total hip arthroplasty (THA).

We examined the effect of femoral head length on fretting and corrosion in retrieved head–neck tapers in vivo for a minimum of two years (mean 8.7 years; 2.6 to 15.9). A total of 56 femoral heads ranging from 28 mm to 3 mm to 28 mm + 8 mm, and 17 femoral stems featuring a single taper design were included in the study. Fretting and corrosion were scored in three horizontally oriented concentric zones of each taper by stereomicroscopy.

Head length was observed to affect fretting (p = 0.03), with 28 mm + 8 mm femoral heads showing greater total fretting scores than all other head lengths. The central zone of the femoral head bore taper was subject to increased fretting damage (p = 0.01), regardless of head length or stem offset. High-offset femoral stems were associated with greater total fretting of the bore taper (p = 0.04).

Increased fretting damage is seen with longer head lengths and high-offset femoral stems, and occurs within a central concentric zone of the femoral head bore taper. Further investigation is required to determine the effect of increased head size, and variations in head–neck taper design.

Cite this article: Bone Joint J 2015; 97-B:911–16.

A modular femoral head–neck junction has practical advantages in total hip replacement. Taper fretting and corrosion have so far been an infrequent cause of revision. The role of design and manufacturing variables continues to be debated. Over the past decade several changes in technology and clinical practice might result in an increase in clinically significant taper fretting and corrosion. Those factors include an increased usage of large diameter (36 mm) heads, reduced femoral neck and taper dimensions, greater variability in taper assembly with smaller incision surgery, and higher taper stresses due to increased patient weight and/or physical activity. Additional studies are needed to determine the role of taper assembly compared with design, manufacturing and other implant variables.

Cite this article: Bone Joint J 2013;95-B, Supple A:3–6.