In the Journals

Orthopedic surgeon reviews common complications associated with taper corrosion after THA

When it comes to taper corrosion after total hip arthroplasty, the most common etiologies of treatment failure include infection, instability, implant loosening and ions, according to Tad M. Mabry, MD, of the Mayo Clinic.

Tad M. Mabry

“Patients requiring revision total hip arthroplasty due to taper corrosion present with a wide spectrum of damage to the bone and surrounding soft tissue,” Mabry told Healio.com/Orthopedics. “With our increasing experience, we have identified the most common etiologies of treatment failure — the four “I”s: infection, instability, implant loosening and ions (recurrent adverse local tissue reaction). The revision surgeon must be aware of these specific complications and have a mitigation strategy for each of them in order to give his or her patients the greatest opportunity for a successful outcome.”

Evaluate for infection

In an article published in The Journal of Arthroplasty, Mabry noted it is critical to evaluate patients with taper corrosion for prosthetic joint infection before revision surgery. He recommends reviewing for historical indicators of infection and looking at all incisions for signs of redness, swelling or local tenderness.

Preoperative patient optimization is also key to reducing the risk of infection, according to Mabry. Surgeons should modify immunosuppressive drugs and anticoagulants to minimize risk of hematoma, check nutritional status of each patient, measure glycemic control for patients with diabetes and consider Staphylococcus aureus screening and decolonization.

“It is recommended that three to five intraoperative tissue cultures should be sent at the time of revision surgery to evaluate for occult infection,” Mabry wrote in the article. “In addition, the revision surgeon should always adhere to the universal principles of surgical site infection prevention: weight adjusted prophylactic antibiotics, careful soft tissue handling and debridement of necrotic tissue, dead space management and meticulous wound closure.”

Prevention of soft tissue damage

To prevent postoperative instability, Mabry noted patients should be evaluated for hip muscle weakness, limping and periarticular swelling, which can be further assessed with cross-sectional imaging.

“Most importantly, to prevent ongoing soft tissue damage as a result of the taper corrosion pathway, it is in the best interest of the patient to undergo the revision surgery as soon as is feasible after diagnosis,” Mabry wrote.

According to Mabry, the revision surgeon should carefully review the multiplanar position of both acetabular and femoral components, and revise if necessary. He added prosthetic hip stability can be enhanced by maximizing the femoral head diameter and femoral head-to-neck ratio.

“Finally, in the setting of the severe abductor necrosis, the revision surgeon should have a lower threshold for the use of a constrained acetabular insert into an appropriately positioned acetabular component,” Mabry wrote.

Be familiar with the implant

Failure to recognize a loose implant at the time of revision and damage to the periarticular bone which can be qualitative, quantitative or both may increase the risk for implant loosening in revision for taper corrosion, according to Mabry. He noted surgeons should be familiar with the implants in place prior to surgery.

“Furthermore, even if the preoperative radiographs appear benign, the revision surgeon must have all available options for bone loss management close at hand,” Mabry wrote.

To prevent ongoing or recurrent adverse local tissue reaction, Mabry noted surgeons should remove cobalt-chrome to the extent possible when performing revision surgery. Highly crosslinked polyethylene acetabular inserts are also preferred at the time of revision surgery for excellent performance and enhanced modularity instead of ceramic inserts. – by Casey Tingle

 

Disclosure: Mabry reports no relevant financial disclosures.

When it comes to taper corrosion after total hip arthroplasty, the most common etiologies of treatment failure include infection, instability, implant loosening and ions, according to Tad M. Mabry, MD, of the Mayo Clinic.

Tad M. Mabry

“Patients requiring revision total hip arthroplasty due to taper corrosion present with a wide spectrum of damage to the bone and surrounding soft tissue,” Mabry told Healio.com/Orthopedics. “With our increasing experience, we have identified the most common etiologies of treatment failure — the four “I”s: infection, instability, implant loosening and ions (recurrent adverse local tissue reaction). The revision surgeon must be aware of these specific complications and have a mitigation strategy for each of them in order to give his or her patients the greatest opportunity for a successful outcome.”

Evaluate for infection

In an article published in The Journal of Arthroplasty, Mabry noted it is critical to evaluate patients with taper corrosion for prosthetic joint infection before revision surgery. He recommends reviewing for historical indicators of infection and looking at all incisions for signs of redness, swelling or local tenderness.

Preoperative patient optimization is also key to reducing the risk of infection, according to Mabry. Surgeons should modify immunosuppressive drugs and anticoagulants to minimize risk of hematoma, check nutritional status of each patient, measure glycemic control for patients with diabetes and consider Staphylococcus aureus screening and decolonization.

“It is recommended that three to five intraoperative tissue cultures should be sent at the time of revision surgery to evaluate for occult infection,” Mabry wrote in the article. “In addition, the revision surgeon should always adhere to the universal principles of surgical site infection prevention: weight adjusted prophylactic antibiotics, careful soft tissue handling and debridement of necrotic tissue, dead space management and meticulous wound closure.”

Prevention of soft tissue damage

To prevent postoperative instability, Mabry noted patients should be evaluated for hip muscle weakness, limping and periarticular swelling, which can be further assessed with cross-sectional imaging.

“Most importantly, to prevent ongoing soft tissue damage as a result of the taper corrosion pathway, it is in the best interest of the patient to undergo the revision surgery as soon as is feasible after diagnosis,” Mabry wrote.

According to Mabry, the revision surgeon should carefully review the multiplanar position of both acetabular and femoral components, and revise if necessary. He added prosthetic hip stability can be enhanced by maximizing the femoral head diameter and femoral head-to-neck ratio.

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“Finally, in the setting of the severe abductor necrosis, the revision surgeon should have a lower threshold for the use of a constrained acetabular insert into an appropriately positioned acetabular component,” Mabry wrote.

Be familiar with the implant

Failure to recognize a loose implant at the time of revision and damage to the periarticular bone which can be qualitative, quantitative or both may increase the risk for implant loosening in revision for taper corrosion, according to Mabry. He noted surgeons should be familiar with the implants in place prior to surgery.

“Furthermore, even if the preoperative radiographs appear benign, the revision surgeon must have all available options for bone loss management close at hand,” Mabry wrote.

To prevent ongoing or recurrent adverse local tissue reaction, Mabry noted surgeons should remove cobalt-chrome to the extent possible when performing revision surgery. Highly crosslinked polyethylene acetabular inserts are also preferred at the time of revision surgery for excellent performance and enhanced modularity instead of ceramic inserts. – by Casey Tingle

 

Disclosure: Mabry reports no relevant financial disclosures.