title: Does Surface Topography Play a Role in Taper Damage in Head-neck Modular Junctions?
abstract: BACKGROUND
  There are increasing reports of total hip arthroplasty failure subsequent to modular taper junction corrosion. The surfaces of tapers are machined to have circumferential machining marks, resulting in a surface topography of alternating peaks and valleys on the scale of micrometers. It is unclear if the geometry of this machined surface topography influences the degree of fretting and corrosion damage present on modular taper junctions or if there are differences between modular taper junction material couples.
  
  
  OBJECTIVE
  (1) What are the differences in damage score and surface topography between CoCr/CoCr and CoCr/Ti modular junctions? (2) How are initial surface topography, flexural rigidity, taper angle mismatch, and time in situ related to visual taper damage scores for CoCr/CoCr couples? (3) How are initial surface topography, flexural rigidity, taper angle mismatch, and time in situ related to visual taper damage scores for CoCr/Ti couples?
  
  
  METHODS
  Damage on stem and head tapers was evaluated with a modified Goldberg score. Differences in damage scores were determined between a group of 140 CoCr/CoCr couples and 129 CoCr/Ti couples using a chi-square test. For a subgroup of 70 retrievals, selected at random, we measured five variables, including initial stem taper machining mark height and spacing, initial head taper roughness, flexural rigidity, and taper angle mismatch. All retrievals were obtained at revision surgeries. None were retrieved as a result of metal-on-metal failures or were recalled implants. Components were chosen so there was a comparable number of each material couple and damage score. Machining marks around the circumference of the tapers were measured using white light interferometry to characterize the initial stem taper surface topography in terms of the height of and spacing between machining mark peaks as well as initial head taper roughness. The taper angle mismatch was assessed with a coordinate measuring machine. Flexural rigidity was determined based on measurements of gross taper dimensions and material properties. Differences of median or mean values of all variables between material couples were determined (Wilcoxon rank-sum tests and t-tests). The effect of all five variables along with time in situ on stem and head taper damage scores was tested with a multiple regression model. With 70 retrievals, a statistical power of 0.8 could be achieved for the model.
  
  
  RESULTS
  Damage scores were different between CoCr/CoCr and CoCr/Ti modular taper junction material couples. CoCr/CoCr stem tapers were less likely to be mildly damaged (11%, p = 0.006) but more likely to be severely damaged (4%, p = 0.02) than CoCr/Ti stem tapers (28% and 1%, respectively). CoCr/CoCr couples were less likely to have moderately worn head tapers (7% versus 17%, p = 0.003). Stem taper machining mark height and spacing and head taper roughness were 11 (SD 3), 185 (SD 46), and 0.57 (SD 0.5) for CoCr/CoCr couples and 10 (SD 3), 170 (SD 56), and 0.64 (SD 0.4) for CoCr/Ti couples, respectively. There was no difference (p = 0.09, p = 0.1, p = 0.16, respectively) for either factor between material couples. Larger stem taper machining mark heights (p = 0.001) were associated with lower stem taper damage scores, and time in situ (p = 0.006) was associated with higher stem taper damage scores for CoCr/CoCr material couples. Stem taper machining marks that had higher peaks resulted in slower damage progression over time. For CoCr/Ti material couples, head taper roughness was associated with higher stem (p = 0.001) and head taper (p = 0.003) damage scores, and stem taper machining mark height, but not time in situ, was associated with lower stem taper damage scores (p = 0.007).
  
  
  CONCLUSIONS
  Stem taper surface topography was related to damage scores on retrieved head-neck modular junctions; however, it affected CoCr/CoCr and CoCr/Ti couples differently.
  
  
  CONCLUSIONS
  A taper topography of circumferential machining marks with higher peaks appears to enable slower damage progression and, subsequently, a reduction of the reported release of corrosion products. This may be of interest to implant designers and manufacturers in an effort to reduce the effects of metal release from modular femoral components.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL, 60612, USA. Robin_Pourzal@rush.edu.
authors.forename: Robin
authors.initials: R
authors.lastname: Pourzal
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL, 60612, USA.
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Hall
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL, 60612, USA.
authors.forename: Nguyen Q
authors.initials: NQ
authors.lastname: Ha
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL, 60612, USA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Urban
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL, 60612, USA.
authors.forename: Brett R
authors.initials: BR
authors.lastname: Levine
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL, 60612, USA.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Jacobs
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611W Harrison Street, Suite 200, Chicago, IL, 60612, USA.
authors.forename: Hannah J
authors.initials: HJ
authors.lastname: Lundberg
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000295:instrumentation*; D016009:Chi-Square Distribution; D002858:Chromium Alloys; D020878:Device Removal; D019544:Equipment Failure Analysis; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D061825:Metal-on-Metal Joint Prostheses; D008855:Microscopy, Electron, Scanning; D020959:Polyethylene; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012044:Regression Analysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013499:Surface Properties; D013997:Time Factors; D014025:Titanium; D017211:Treatment Failure
chemical_list: D002858:Chromium Alloys; D020959:Polyethylene; D014025:Titanium