Adapter sleeves are essential for ceramic heads in hip revision surgery.

BACKGROUND: Removing a head during isolated acetabular revision surgery can cause damage to the stem taper surface from extraction tool contact. Implanting a ceramic head on the damaged stem taper might elevate the fracture risk, which can be mitigated with the use of titanium adapter sleeves. The aim of this study was to investigate whether the improved fracture strength of modern generation ceramic heads allows the direct implantation on damaged stem tapers without an adapter sleeve. METHODS: Finite element models of taper junctions with and without adapter sleeve were generated. Different stem taper damages were modelled to investigate the influence on the ceramic head fracture load under axial compression. FINDINGS: Heads without adapter sleeves exhibited slightly higher or equal fracture strengths compared with sleeved heads for most scenarios. However, a small metal elevation on the stem taper caused a drastic decrease of the fracture strength if no adapter sleeve was used (-96%). The sleeved head was not influenced by the metal elevation damage. INTERPRETATION: Adapter sleeves are essential to ensure patient safety and prosthesis longevity whenever implanting ceramic heads on used stem tapers.

Impact of stem taper damage on the fracture strength of ceramic heads with adapter sleeves.

BACKGROUND: Using a new ceramic head with a titanium adapter sleeve offers the possibility of maintaining a well fixed stem when conducting cup revision of a total hip arthroplasty. The aim of this study is to test the impact of stem taper damage on the fracture strength of sleeved ceramic heads. METHODS: Pristine zirconia-toughened alumina heads with titanium adapter sleeves (BIOLOX®OPTION System) were tested on damaged Ti-4Al-6V stem tapers in accordance with ISO7206-10. Four distinctive damage types classified as intolerable by the manufacture were investigated, representing various reductions in contact area between the stem taper and sleeve taper as well as damage incurred from previous ceramic head fracture. FINDINGS: The largest reduction in fracture strength occurred for a loss of contact for the entire length of the stem taper. Nonetheless, the fracture strength in all investigated cases was several times higher than that defined by the FDA standards. INTERPRETATION: The use of a titanium sleeve recreates a uniform contact situation between the ceramic head and the outer sleeve taper in situations of damaged stem tapers. For the investigated damage types a high fracture strength of the ceramic head was maintained. This study supports the clinical use for sleeved ceramic heads in instances of greater damages of stem tapers than previously defined in order to spare patients from stem removal.

Head Taper Corrosion Causing Head Bottoming Out and Consecutive Gross Stem Taper Failure in Total Hip Arthroplasty.

BACKGROUND: Taper corrosion in total hip arthroplasty for bearings with metal heads against polyethylene has developed from an anecdotal observation to a clinical problem. Increased taper wear and even gross taper failure have been reported for one particular design. It is hypothesized that corrosion of the female head taper results in taper widening, allowing the cobalt-chromium head to turn on the stem and wear down the softer titanium alloy by abrasive wear, ultimately causing failure. The purpose of this study is to investigate the time course of this process and the general role of taper dimensions and material in this problem. METHODS: Retrieved cobalt-chromium alloy heads (n = 30, LFIT; Stryker, Mahwah, NJ) and Ti-12Mo-6Zr-2Fe (TMZF) stems (n = 10, Accolade I; Stryker) were available for analysis. Taper material loss was determined using three-dimensional coordinate measurements and scanning. The pristine tip clearance between head and stem was analytically determined. The influence of taper material and taper size on taper deformation and micromotion was investigated using a finite element model. RESULTS: Material loss at the head taper increased with time in situ up to a volume of 20.8 mm3 (P < .001). A mean linear material loss above 76 µm at the head taper was analytically confirmed to result in bottoming out, which was observed in 12 heads. The finite element calculations showed significantly larger deformations and micromotions for a small 11/13 TMZF taper combined with a distinctly different micromotion pattern compared to other materials and taper designs. CONCLUSION: A 11/13 TMZF taper design with 36-mm head diameters bears a higher risk for corrosion than larger tapers made from stiffer materials. Failures of this combination are not restricted to the head sizes included in the recall. Patients with this implant combination should be closely monitored.