Three Femoral Stem Designs Without Corrosion: A Review of 2095 Stems

Douglas DR Naudie,1,2 Silvio Ndoja,1 Thomas J Wood,3 Lyndsay E Somerville,1 James L Howard,1,2 Richard W McCalden,1,2 Steven J MacDonald,1,2 Brent A Lanting1,2 1Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences, London, Ontario, Canada; 2Bone and Joint Institute, Western University, London, Ontario, Canada; 3Division of Orthopaedic Surgery, Department of Surgery, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, CanadaCorrespondence: Douglas DR NaudieDivision of Orthopaedic Surgery, Department of Surgery, Western University, Schulich School of Medicine, London Health Sciences Centre, University Campus, A9-028,339 Windermere Road, London, Ontario N6A 5A5, CanadaEmail Douglas.Naudie@lhsc.on.caIntroduction: Corrosion at the head–neck interface of modular components in total hip arthroplasty (THA) has been reported as a cause of failure of modern total hip replacement implants. While this method of failure has been well described, it remains poorly understood. The purpose of this study is to review the three most commonly used uncemented femoral stems at our institution over the last fifteen years and to correlate any established risk factors with rates of revision, particularly corrosion.Methods: We reviewed 2095 patients from March 2000 to September 2015 who underwent total hip arthroplasty with one of three uncemented femoral stem designs. All stems were made of a Ti6Al4V alloy with a 12/14 taper design. We included only those stems coupled with a CoCr head and a highly crosslinked polyethylene liner. We evaluated age, gender, body mass index (BMI), femoral head size, head length, neck angle and offset and correlated these to the incidence of all cause revision, as well as revision excluding infection.Results: There were no recognized corrosion-related revisions identified. There was no association between age, BMI, gender, head length, neck angle and offset to all cause revision or revision with infection excluded (p> 0.05). Femoral head size less than 32mm was associated with higher all cause revision rates (OR 4.60 (95% CI 1.8, 11.8)) and when excluding infection as a reason for revision (OR 4.94 (95% CI 1.7, 14.41)).Conclusion: Over the last fifteen years, we have not identified any cases of corrosion with the three most commonly used femoral stems used at out institution. While we acknowledge that no femoral stem is immune to corrosion, certain femoral stem designs may be uniquely resistant to this mode of failure.Level of Evidence: III.Keywords: corrosion, revision, total hip arthroplasty, femoral stems

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