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Liner dissociation leading to catastrophic failure of an Oxinium femoral head.

ABSTRACT: Oxinium is an alternative bearing surface designed to emulate the superior wear and scratch properties of ceramic femoral heads in total hip arthroplasty while minimizing the risk for brittle fracturing. However, recent studies have indicated that hip dislocation following total hip arthroplasty may be a risk factor for catastrophic failure of the femoral head. Here, we report on a novel case of a catastrophic Oxinium head and polyethylene liner failure in the absence of previous hip dislocation or trauma and review the probable failure mechanism. This report underscores the need to be vigilant about proper acetabular cup and liner seating, particularly in the setting of Oxinium femoral head use. In the event of Oxinium head failure, metallosis may compromise stabilizing soft tissues including the abductors. Dual-mobility articulation, which was successful in this case, is one option to consider when the risk for chronic redislocation is elevated.

SUBMITTER: Zou AH

PROVIDER: S-EPMC6470327 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Liner dissociation leading to catastrophic failure of an Oxinium femoral head.

Zou Anthony H AH Novikov David D Feng James E JE Anoushiravani Afshin A AA Schwarzkopf Ran R Vigdorchik Jonathan M JM

Arthroplasty today 20181128 1

Oxinium is an alternative bearing surface designed to emulate the superior wear and scratch properties of ceramic femoral heads in total hip arthroplasty while minimizing the risk for brittle fracturing. However, recent studies have indicated that hip dislocation following total hip arthroplasty may be a risk factor for catastrophic failure of the femoral head. Here, we report on a novel case of a catastrophic Oxinium head and polyethylene liner failure in the absence of previous hip dislocation ...[more]

PMID: 31020016

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Project description:BackgroundGross trunnion failure (GTF) is a rare complication in total hip arthroplasty (THA) reported across a range of manufacturers. Specific lots of the Stryker low friction ion treatment (LFIT) anatomic cobalt chromium alloy (CoCr) V40 femoral head were recalled in August 2016. In part, the recall was based out of concerns for disassociation of the femoral head from the stem and GTF.MethodsWe report on 28 patients (30 implants) with either GTF (n = 18) or head-neck taper corrosion (n = 12) of the LFIT CoCr femoral head and the Accolade titanium-molybdenum-zirconium-iron alloy femoral stems. All these cases were associated with adverse local tissue reactions requiring revision of the THA.ResultsIn our series, a conservative estimate of the incidence of failure was 4.7% (n = 636 total implanted) at 8.0 ± 1.4 years from the index procedure. Failures were associated with a high-offset 127° femoral stem neck angle and increased neck lengths; 43.3% (13 of 30) of the observed failures included implant sizes outside the voluntary recall (27.8% [5 of 18] of the GTF and 75.0% [8 of 12] of the taper corrosion cases). Serum cobalt and chromium levels were elevated (cobalt: 8.4 ± 7.0 μg/mL; chromium: 3.4 ± 3.3 μ/L; cobalt/chromium ratio: 3.7). The metal artifact reduction sequence magnetic resonance imaging demonstrated large cystic fluid collections typical with adverse local tissue reactions. During revision, a pseudotumor was observed in all cases. Pathology suggested a chronic inflammatory response. Impending GTF could be diagnosed based on aspiration of black synovial fluid and an oblique femoral head as compared with the neck taper on radiographs.ConclusionIn our series of the recalled LFIT CoCr femoral head, the risk of impending GTF or head-neck taper corrosion should be considered as a potential diagnosis in a painful LFIT femoral head and Accolade titanium-molybdenum-zirconium-iron alloy THA with unknown etiology. Almost half of the failures we observed included sizes outside of the voluntary recall.

Dataset Information

Liner dissociation leading to catastrophic failure of an Oxinium femoral head.

Publications

Liner dissociation leading to catastrophic failure of an Oxinium femoral head.

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