NDLI: The surgical options and clinical evidence for treatment of wear or corrosion occurring with THA or TKA.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Engh, Charles A. Ho, Henry Padgett, Douglas E.
Description	Country affiliation: United States Author Affiliation: Engh CA ( Anderson Orthopaedic Research Institute, PO Box 7088, Alexandria, VA, 22307, USA.)
Abstract	BACKGROUND: Wear and corrosion occurring in patients with hip and knee arthroplasty are common causes of failure leading to revision surgery. A variety of surgical approaches to these problems have been described, with varying efficacy. Polyethylene wear, metal-on-metal (MoM) hip bearing wear, and problems associated with modular taper corrosion are the areas of greatest clinical impact; results of revisions for these problems are likely to dictate a large portion of revision resources for the foreseeable future, and so they call for specific study. QUESTIONS/PURPOSES: We identified the most frequently reported procedures to treat hip polyethylene wear, knee polyethylene wear, MoM wear after THA, and modular taper corrosion and determined the timing and reasons these failed. METHODS: We performed systematic reviews of the published literature on the four topics using MEDLINE(®) and Embase in October 2013; searches were supplemented by hand searches of bibliographies. Prespecified criteria resulted in the identification of 38 relevant articles, of which 33 were either case reports or Level IV evidence. Followup was generally at short term and ranged from 0.2 to 8 years. RESULTS: The most frequently reported procedures for treating clinically important wear were a partial or complete revision. When treating polyethylene wear, the more frequently reported reasons for hip and knee rerevisions were loosening, continued wear, and instability. Soft tissue reactions were more common and occasionally extensive in patients with MoM or modular taper corrosion. Patients with soft tissue reactions had more complications and higher rerevision rates. CONCLUSIONS: Studies with longer followup and higher levels of evidence are needed to direct the treatment of wear and corrosion. When soft tissue damage secondary to MoM wear or taper corrosion is present, the results of treatment can be poor. There is an urgent need to better understand these two mechanisms of failure.
File Format	HTM / HTML
ISSN	0009921X
e-ISSN	15281132
DOI	10.1007/s11999-014-3652-4
Journal	Clinical Orthopaedics and Related Researchtextregistered
Issue Number	12
Volume Number	472
Language	English
Publisher	Springer
Publisher Date	2014-12-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Orthopaedics Arthroplasty, Replacement, Hip Instrumentation Arthroplasty, Replacement, Knee Foreign-body Reaction Surgery Hip Joint Hip Prosthesis Joint Instability Knee Joint Knee Prosthesis Prosthesis Failure Adverse Effects Biomechanical Phenomena Corrosion Diagnosis Etiology Physiopathology Metal-on-metal Joint Prostheses Polyethylene Prosthesis Design Reoperation Stress, Mechanical Time Factors
Content Type	Text
Resource Type	Article
Subject	Orthopedics and Sports Medicine Surgery Sports Science

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What are the current clinical issues in wear and tribocorrosion?

Current modes of failure in TKA: infection, instability, and stiffness predominate.

How have alternative bearings and modularity affected revision rates in total hip arthroplasty?

How have new bearing surfaces altered the local biological reactions to byproducts of wear and modularity?

Does increased topside conformity in modular total knee arthroplasty lead to increased backside wear?

Taper design affects failure of large-head metal-on-metal total hip replacements.

Tibial post wear in posterior-stabilized knee replacements is design-dependent.

Do retrieval analysis and blood metal measurements contribute to our understanding of adverse local tissue reactions?

ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements. : Editorial

The surgical options and clinical evidence for treatment of wear or corrosion occurring with THA or TKA.

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What are the current clinical issues in wear and tribocorrosion?

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ABJS Carl T. Brighton Workshop on Implant Wear and Tribocorrosion of Total Joint Replacements. : Editorial

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