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Evidence based recommendations for reducing head-neck taper connection fretting corrosion in hip replacement prostheses

Abstract

Introduction

This systematic review seeks to summarise the published studies investigating prosthetic design, manufacture and surgical technique’s effect on fretting corrosion at the head-neck taper connection, and provide clinical recommendations to reduce its occurrence.

Methods

PubMed, MEDLINE and EMBASE electronic databases were searched using the terms taper, trunnion, cone and head-neck junction. Articles investigating prosthetic design, manufacture and surgical technique’s effect on fretting corrosion were retrieved, reviewed and graded according to OCEBM levels of evidence and grades of recommendation.

Results

The initial search yielded 1,224 unique articles, and 91 were included in the analysis.

Conclusions

There is fair evidence to recommend against the use of high offset femoral heads, larger diameter femoral heads, and to pay particular consideration to fretting corrosion’s progression with time and risk with heavier or more active patients. Particular to metal-on-metal hip prostheses, there is fair evidence to recommend positioning the acetabular component to minimise edge loading. Particular to metal-on-polyethylene hip prostheses, there is fair evidence to recommend the use of ceramic femoral heads, against use of cast cobalt alloy femoral heads, and against use of low flexural rigidity femoral stems. Evidence related to taper connection design is largely conflicting or inconclusive. Head-neck taper connection fretting corrosion is a multifactorial problem. Strict adherence to the guidelines presented herein does not eliminate the risk. Prosthesis selection is critical, and well-controlled studies to identify each design parameter’s relative contribution to head-neck taper connection fretting corrosion are required.

Hip Int 2017; 27(6): 523 - 531

Article Type: REVIEW

DOI:10.5301/hipint.5000545

Authors

Christian M. Wight, Brent Lanting, Emil H. Schemitsch

Article History

Disclosures

Financial support: None.
Conflict of interest: B.L. has ownership in PersaFix Revisions Technology Inc, IdealFit Spacer Solutions and IdealFit Spacer Technology. C.M.W. and E.H.S. have no conflict of interest.

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Authors

Affiliations

  • Institute of Biomaterial and Biomedical Engineering, University of Toronto, Toronto, Ontario - Canada
  • Division of Orthopaedic Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario - Canada

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