Is There Material Loss at the Conical Junctions of Modular Components for Total Knee Arthroplasty?

• Published in: The Journal of arthroplasty 2019-10, Vol.34 (10), p.2479-2486
• Main Authors: Spece, Hannah, Underwood, Richard J., Baykal, Doruk, Eiselstein, Lawrence E., Torelli, Daniel A., Klein, Gregg R., Lee, Gwo-Chin, Kurtz, Steven M.
• Format: Article
• Language: English
• Subjects: corrosion; fretting; material loss; modularity; retrieval; TKA
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2019.05.030

Clinical concern exists regarding fretting corrosion and material loss from taper junctions in orthopedic devices, with previous research focusing on the modular components from total hip arthroplasty. Comparatively little has been published regarding the fretting corrosion and material loss in modular knee devices. The purpose of this study is to evaluate fretting corrosion damage and quantify material loss for conical total knee arthroplasty taper interfaces. Stem tapers of 166 retrieved modular knee devices were evaluated for fretting corrosion using a semiquantitative scoring method. High precision profilometry was then used to determine volumetric material loss and maximum wear depth for a subset of 37 components (implanted for 0.25-18.76 years). Scanning electron microscopy and energy-dispersive X-ray spectroscopy were used to characterize the observed damage. Mild to severe fretting corrosion was observed on the majority of tapers, with 23% receiving a maximum visually determined damage score of 4. The median rate of volumetric material loss was 0.11 mm3/y (range 0.00-0.76) for femoral components (both cone and bore taper surfaces combined) and 0.01 mm3 (range 0.00-8.10) for tibial components. Greater rates of material loss were associated with mixed metal pairings. There was a strong correlation between visual fretting corrosion score and calculated material loss (ρ = 0.68, P < .001). Scanning electron microscopy revealed varying degrees of scratching, wear, fretting corrosion, and instances of cracking with morphology not consistent with fretting corrosion, wear, or fatigue. Although visual evidence of fretting corrosion damage was prevalent and correlated with taper material loss, the measured volumetric material loss was low compared with prior reports from total hip arthroplasty.