Fracture of Cobalt-Crome Modular Neck in Total Hip Arthroplasty

Luigi Murena; Guido Maritan; Chiara  Concina; Veronica Scamacca; Chiara Ratti; Gianluca  Canton

doi:10.23750/abm.v90i12-S.8941

Fracture of Cobalt-Crome Modular Neck in Total Hip Arthroplasty

Authors

Luigi Murena Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)
Guido Maritan Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)
Chiara Concina Orthopaedics and Traumatology Unit, Monfalcone Hospital-AAS2, Via Galvani 1, 34074 Monfalcone (Italy)
Veronica Scamacca Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)
Chiara Ratti Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)
Gianluca Canton Orthopaedics and Traumatology Unit, Cattinara Hospital – ASUITS, Strada di Fiume 447, 34149 Trieste (Italy)

DOI: https://doi.org/10.23750/abm.v90i12-S.8941

Keywords:

Cobalt-Crome, Modular neck fracture, Total Hip replacement, Hip arthroplasty, Risk factors

Abstract

Despite the advantages of modular total hip arthroplasty in terms of neck version, offset and length precise reproduction, titanium necks breakage became a concern. Consequently, titanium has been replaced by cobalt-chrome (Co-Cr). However, four cases of Co-Cr modular neck breakage have been reported in the literature. In the present paper, two cases of Co-Cr modular neck fractures are described together with a literature review. The aim of this work is to discuss the risk factors and characteristics of this rare complication. We described two cases of fracture of long varus Co-Cr modular femoral neck connected with cementless press-fit stem. Some risk factors, such as long varus type of modular neck, overweight and/or high demanding physical activity, might have contributed to implant failure.

References

1. Vendittioli PA, Roy A, Mottard S, et al. Metal ion release from bearing wear and corrosion with 28mm and large –diameter metal-on-metal bearing articulations: a follow-up study. J Bone Joint Surg (Br) 2010; 92: 12-19.
2. Grupp TM, Weik T, Bloemer W, et al. Modular titanium alloy neck adapter failures in hip replacement-failure mode analysis and influence of implant material. BMC Muskuloskelet Desord 2010; 11: 3-14.
3. Mencière M-L, Amouyel T, J. Taviaux J, et al. Fracture of the cobalt-chromium modular femoral neck component in total hip arthroplasty. Orthop Traumatol Surg Res 2014; 100: 565–568.
4. Kovac S, Mavcic B, Kotnik M, et al. What Factors Are Associated With Neck Fracture in One Commonly Used Bimodular THA Design? A Multicenter, Nationwide Study in Slovenia. Clin Orthop Relat Res 2019; 466(6): 1324-1332
5. Chmell MJ, Rispler D, Poss R. The impact of modularity in total hip arthroplasty. Clin Orthop 1995; 319: 77-84.
6. Barrack RL. Modularity of prosthetic implants. J Am Acad Orthop Surg 1994; 2: 16-25.
7. Jones RE. Modular revision stems in total hip arthroplasty. Clin Orthop 2004; 420: 142.
8. Wodeki P, Sabbah D, Kermarrec G, et al. New type of hip arthroplasty failure related to modular femoral components: Breakage at the neck-stem junction. Orthop Traumatol Surg Res 2013; 99: 741-744.
9. Ellman MB, Levine BR. Fracture of the modular femoral neck component in total hip arthrolplasty. J Arthroplasty 2013; 28: 196
10. Dangles CJ, Altstetter CJ. Failure of the modular neck in a total hip arthroplasty. J Arthroplasty 2010; 25: 1169 [e5–7].
11. Kop AM, Swarts E. Corrosion of a hip stem with a modular neck taper junction: a retrieval study of 16 cases. J Arthroplasty 2009; 24: 1019-23.
12. Jones DM, Marsh JL, Nepola JV, et al. Focal osteolysis at the junctions of a modular stainless-steel femoral intramedullary nail. J Bone Joint Surg Am 2001; 83: 537-48.
13. Lee SH, Brennan FR, Jacobs JJ, et al. Human monocyte/macrophage response to cobalt-chromium corrosion products and titanium particles in patients with total joint replacements. J Orthop Res 1997; 15: 40-9.
14. Wilson DA, Dunbar MJ, Amirault JD, et al. Early failure of a modular femoral neck total hip arthroplasty component: a case report. J Bone Joint Surg Am 2010; 92: 1514–7.
15. Skendzel JG, Blaha JD, Urquhart AG. Total hip arthroplasty modular neck failure. J Arthroplasty 2011; 26: 338.
16. Wright CG, Sporer S, Urban R, et al. Fracture of a modular femoral neck after total hip arthroplasty. J Bone Joint Surg Am 2010; 92(6): 1518-1521.
17. Nganbe M, Khan U, Louati H, et al. In vitro assessment of strength, fatigue durability, and disassembly of Ti6Al4V and CoCrMo necks in modular total hip replacements. J Biomed Mater Res B Appl Biomater 2011; 97(1): 132–138.
18. US Food and Drug Administration. MAUDE database. Available at: www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm. Accessed May 19, 2019.