title: Retrieval Analysis of Neck-Stem Coupling in Modular Hip Prostheses.
abstract: Dual-taper modular stems have suffered from high revision rates caused by adverse local tissue reactions secondary to fretting and corrosion. We compared the fretting and corrosion behavior of a group of modular neck designs to that of a design that had been recalled for risks associated with fretting and corrosion at the modular neck junction.
  
  
  
  We previously analyzed fretting and corrosion on 60 retrieved Rejuvenate modular neck-stem implants. Here we compare those results to results from 26 retrieved implants from 7 other modular neck designs. For the 26 additional cases, histology slides of tissue collected at revision were reviewed and graded for aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL). Multivariate analyses were performed to assess differences in fretting and corrosion, adjusting for confounding factors (eg, length of implantation).
  
  
  
  The Rejuvenate design had higher damage and corrosion scores than the other 7 designs (P < .01). Histologic samples from the recalled design were 20 times more likely to show ALVAL than samples from the other designs (P < .01). Mixed metal couples had higher fretting (P < .01) and corrosion (P = .02) scores than non-mixed metal couples.
  
  
  
  Fretting and corrosion occurred on all modular neck-stem retrievals regardless of design. However, mixed metal couples suffered more corrosion than homogenous couples. This may be due to the lower modulus of the titanium alloy used for the stem, allowing for increased metal transfer and surface damage when loaded against a cobalt alloy modular neck, which in turn could account for the higher ALVAL and corrosion scores. Due to increased corrosion risk with mixed metals and increased neck fracture risk with non-mixed metal stem and necks, we suggest that clinicians avoid implantation of modular neck-stem systems.
authors.affiliation: Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: Sherwin L
authors.initials: SL
authors.lastname: Su
authors.affiliation: Department of Biomechanics, Hospital for Special Surgery, New York, New York.
authors.forename: Chelsea N
authors.initials: CN
authors.lastname: Koch
authors.affiliation: Department of Biomechanics, Hospital for Special Surgery, New York, New York.
authors.forename: Thu M
authors.initials: TM
authors.lastname: Nguyen
authors.affiliation: Healthcare Research Institute, Hospital for Special Surgery, New York, New York.
authors.forename: Jayme C
authors.initials: JC
authors.lastname: Burket
authors.affiliation: Department of Biomechanics, Hospital for Special Surgery, New York, New York.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Wright
authors.affiliation: Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, New York, New York.
authors.forename: Geoffrey H
authors.initials: GH
authors.lastname: Westrich
mesh_terms: D000328:Adult; D000368:Aged; D000497:Alloys; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D003035:Cobalt; D003343:Corrosion; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007717:Knee / Q000473:pathology; D008297:Male; D008670:Metals; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D014025:Titanium
chemical_list: D000497:Alloys; D008670:Metals; D003035:Cobalt; D014025:Titanium
keywords: adverse local tissue reaction; corrosion; fretting; modular neck; total hip arthroplasty