How to diagnose taper corrosion


Taper junction corrosion in total hip replacements is a growing concern; it is also a multi-faceted problem. With both asymptomatic and symptomatic patient groups, what indications should a surgeon look for when corrosion is suspected? While there is not a single test to isolate corrosion problems, a spectrum of diagnostic tools have been suggested to make a diagnosis.


Corrosion of the head-neck or taper junction in modular total hip implants has increasingly been reported [1, 2]. While several co-mingling factors have been identified as contributors to the problem (see Part I of this article series), patients may or may not display symptoms, which can make it challenging to identify corrosion through symptoms. In some cases, corrosion has not been identified or confirmed until during revision, and these patients may experience higher rates of complications [3]. Symptoms patients may display cover a broad range and include, but are not limited to: pain, instability, elevated serum metal levels, adverse local tissue reactions (ALTR), swelling, in rare cases neurological changes, and more.

It can take upwards of eight months to establish corrosion as a diagnosis and perform retrieval [4] and Kwon cautions against overreliance on any single diagnostic tool [5]. Here we look at a selection of clinical indicators that may help identify or eliminate corrosion and/or associated metal toxicity as a cause for concern.

 

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  • When to suspect corrosion
  • Pain as a possible initial symptom
  • Is it an infection?
  • Serum metal levels may be elevated
  • Evidence of adverse local tissue reaction?
  • Use of imaging technology
  • Rare cases
  • Conclusion
  • References
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Contributing experts

This series of articles was created with the support of the following specialists (in alphabetical order):

Moussa Hamadouche MD, PhD

Cochin University Hospital, Paris, France

Michael Morlock PhD

Hamburg University of Technology
Hamburg, Germany

Carsten Perka

Carsten Perka MD

Charité—Universitaetsmedizin, Berlin, Germany

This issue was created by Word+Vision Media Productions, Switzerland

 

References

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  2. Morlock M, Bünte D, Gührs J, et al. Corrosion of the head-stem taper junction—Are we on the verge of an epidemic? HSS J. 2016 Oct;12(3).
  3. Lash NJ, Whitehouse MR, Greidanus NV, et al. Delayed dislocation following metal-on-polyethylene arthroplasty of the hip due to 'silent' trunnion corrosion. Bone Joint J. 2016 Feb;98-B(2):187-193.
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