Failure of an ACCIS metal-on-metal hip resurfacing prosthesis: A case report

Abstract

The introduction of coatings on joint replacements was intended to reduce wear volumes, prevent corrosion and reduce metal ion release. However, retrieval analysis to confirm their in vivo performance has been limited. The aim of study was to examine the coating on a retrieved hip prosthesis to determine whether substantial damage or wear had occurred. A single advanced ceramic-coated implant systems titanium niobium nitride-coated hip resurfacing prosthesis was retrieved for examination. Wear volumes and surface roughness were measured to quantify the damage to the articulating surfaces. The coating had been completely removed from substantial parts of both the femoral head and the acetabular cup, corresponding to areas of wear as measured by a coordinate measuring machine. The total wear rate (61 mm³/year) was high and corresponded with the high metal ion levels recorded pre-operatively (83 ppb chromium and 110 ppb cobalt). Roughness data indicated that the coating has a lower roughness than the substrate and substantially lower than the boundary between the coating and the substrate. The wear rate is very high and it is likely that damage to the coating resulted in accelerated wear of the prosthesis. No sudden change between the boundary of the substrate and the coating was observed that would indicate delamination or failure of the coating substrate interface layer. While coatings may offer some theoretical benefits, they may also result in catastrophic failure of the prosthesis.

Keywords

Wear analysis/testing (biomechanics)tribology of coatings orthopaedic tribology orthopaedic materials surfaces blood metal ion levels

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References

Hamelynck

Woering

. The advanced ceramic coated implant systems (ACCIS) hip resurfacing prosthesis. In: De Smet

Campbell

Van Der Straeten

(eds) The hip resurfacing handbook: a practical guide to the use and management of modern hip resurfacings. Cambridge: Woodhead Publishing, 2013, pp.3–10.

Hamelynck

Woering

. Ceramic surface engineered metal-on-metal hips system for total hip arthroplasty and resurfacing hip arthroplasty (White paper). Buxtehude: implantcast, 2009.

De Villiers

Hothi

Khatkar

et al . Lessons from retrievals: retrievals help understand the reason for revision of coated hip arthroplasties. Proc IMechE, Part H: J Engineering in Medicine 2015; 229: 804–811.

Jemmett

Parfitt

Rice

. Early clinical failure of the ACCIS metal on metal hip arthroplasty system – a metal on metal hip with a difference. Acta Orthop Belg 2016; 82: 491–496.

Łapaj

Markuszewski

Wendland

et al . Massive failure of TiNbN coating in surface engineered metal-on-metal hip arthroplasty: retrieval analysis. J Biomed Mater Res B Appl Biomater 2016; 104: 1043–1049.

Medicines and Healthcare products Regulatory Agency (MHRA). MDA/2012/036 appendix: management recommendations for patients with metal-on-metal hip replacement implants. London: MHRA, 2012.

Lord

Langton

Nargol

AVF

et al . Volumetric wear assessment of failed metal-on-metal hip resurfacing prostheses. Wear 2011; 272: 79–87.

Langton

Sidaginamale

Holland

et al . Practical considerations for volumetric wear analysis of explanted hip arthroplasties. Bone Joint Res 2014; 3: 60–68.

ISO 7206-2:2011. Implants for surgery–partial and total hip joint prostheses–part 2: articulating surfaces made of metallic, ceramic and plastics materials.

10.

Naylor

Talwalkar

Trail

et al . Evaluating the surface topography of pyrolytic carbon finger prostheses through measurement of various roughness parameters. J Funct Biomater 2016; 7: 9.

11.

Langton

Jameson

Joyce

et al . Accelerating failure rate of the ASR total hip replacement. J Bone Joint Surg Br 2011; 93: 1011–1016.

12.

Witzleb

Hanisch

Ziegler

et al . In vivo wear rate of the Birmingham Hip Resurfacing arthroplasty. A review of 10 retrieved components. J Arthroplasty 2009; 24: 951–956.

13.

Morlock

Bishop

Zustin

et al . Modes of implant failure after hip resurfacing: morphological and wear analysis of 267 retrieval specimens. J Bone Joint Surg Am 2008; 90(Suppl. 3): 89–95.

14.

Langton

Sidaginamale

Joyce

et al . The clinical implications of elevated blood metal ion concentrations in asymptomatic patients with MoM hip resurfacings: a cohort study. BMJ Open 2013; 3: e001541.

15.

Sidaginamale

Joyce

Lord

et al . Blood metal ion testing is an effective screening tool to identify poorly performing metal-on-metal bearing surfaces. Bone Joint Res 2013; 2: 84–95.

16.

Bone

Cunningham

Lord

et al . Analysis of failed Van Straten LPM proximal interphalangeal prostheses. J Hand Surg Eur Vol 2013; 38: 313–320.

17.

Joyce

Langton

Jameson

et al . Tribological analysis of failed resurfacing hip prostheses and comparison with clinical data. Proc IMechE, Part J: J Engineering Tribology 2009; 223: 317–323.

18.

Hauert

Thorwarth

Müller

et al . Analysis of the in-vivo failure of the adhesive interlayer for a DLC coated articulating metatarsophalangeal joint. Diam Relat Mater 2012; 25: 34–39.

19.

National Joint Registry. 12th annual report of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, 2015 http://www.njrcentre.org.uk/njrcentre/Portals/0/Documents/England/Reports/12th%20annual%20report/NJR%20Online%20Annual%20Report%202015.pdf.