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Case Reports
. 2021 Feb 26:8:35-39.
doi: 10.1016/j.artd.2020.12.018. eCollection 2021 Apr.

Bilateral Mechanically-Assisted Crevice Corrosion Resulting in Femoral Stem-Head Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty

Timothy McAleese  1 , Iain Feeley  1 , Andrew Hughes  1 , Eoin Sheehan  1   2 , Khalid Merghani  1   2 , Dorothy Niall  1   2
Affiliations
Case Reports

Bilateral Mechanically-Assisted Crevice Corrosion Resulting in Femoral Stem-Head Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty

Timothy McAleese et al. Arthroplast Today. .

Abstract

There are emerging reports of complications related to corrosion in modular femoral components. We report a unique case describing an 83-year-old man with bilateral mechanically-assisted crevice corrosion in hip replacements performed 10 years previously, by the same surgeon using the same size 3 Accolade TMZF stem and same 44-mm CoCr LFIT V40 head (Stryker Orthopedics, Mahwah NJ). Our patient presented with complete femoral stem-head complex dissociation of his right hip and elevated serum cobalt and chromium levels. He subsequently underwent right hip revision arthroplasty while his contralateral hip is monitored closely as an outpatient. This case helps to define the poorly understood mechanisms and component design factors implicated in this emerging issue. We also hope to provoke discussions about guidelines for monitoring and revising failing metal-on-polyethylene arthroplasty systems.

Keywords: Accolade TMZF; LFIT V40 cobalt-chrome head; Mechanically-assisted cervice corrosion; Metal on polyethylene arthroplasty; Modular femoral head dissociation.

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Figures

Figure 1
Figure 1
(a, b) Antero-posterior XR performed on presentation showed complete head-neck taper dissociation with malalignment and shortening. No obvious signs of peri-prosthetic osteolysis, suggestive of infection or component loosening. Advanced imaging was unnecessary because of the obvious need for revision. (c) The contralateral left THA showed peripheralization of the femoral stem in relation to the femoral head. This may demonstrate asymmetrical trunnion wear and impending dissociation.
Figure 2
Figure 2
(a) The recovered accolade TMZF explant showed severe corrosion of the modular junction and corrosion of the medial portion of the femoral neck. (b) There was no increased wear visible inside or outside the size 44/0 cobalt-chrome head. (c, d) Rotational views of the recovered explant demonstrate the extent of corrosion present without fracturing of the stem.
Figure 3
Figure 3
Post operative XR showed successful single-stage revision with a cemented exeter stem. The femoral stem of the contralateral left hip remains off-centre in relation to the femoral head.
See this image and copyright information in PMC

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