The management of the patient with a recalled, modular neck-body total hip arthroplasty can be complex, as it involves a combination of clinical, technical, and medicolegal challenges. Management begins with a thorough history and physical exam, radiographic evaluation, infection workup, and serum metal ion levels. Three-dimensional imaging is obtained based on patient symptomatology and metal ion levels and is used to evaluate for the presence of an adverse local tissue response as well as the integrity of the existing soft tissue envelope. The decision to perform revision surgery is based on a combination of patient symptomatology, laboratory values, and imaging findings. Revision surgery involves the entire armamentarium of femoral revision techniques, and the acetabulum may need to be revised at the surgeon’s discretion. The femoral implant can often be removed without disrupting the femoral bone envelope; however, the surgeon should have a low threshold to perform an extended trochanteric osteotomy.
This is a preview of subscription content, log in to check access.
Buy single article
Instant unlimited access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Older J. Charnley low-friction arthroplasty: a worldwide retrospective review at 15 to 20 years. J Arthroplasty. 2002;17(6):675–80.
Cooper HJ, Urban RM, Wixson RL, Meneghini RM, Jacobs JJ. Adverse local tissue reaction arising from corrosion at the femoral neck-body junction in a dual taper stem with a cobalt-chromium modular neck. J Bone Joint Surg Am. 2013;95(10):865–2. Article is of major importance as it was the first to describe the clinical presentation and intra-operative findings of dual taper modular THA corrosion in the Stryker Rejuvenate and ABGII stems. It also identified mechanically assisted crevice corrosion as the likely mechanism of failure in the dual modular stem design.
Molloy DO, Munir S, Jack CM, Cross MB, Walter WL, Walter Sr WK. Fretting and corrosion in modular-neck total hip arthroplasty femoral stems. J Bone Joint Surg Am. 2014;96(6):488–93. Article is of importance as it confirmed the clinical, radiographic, and intra-operative findings of neck-stem mechanically assisted corrosion in the Stryker ABGII femoral stem.
Meftah M, Haleem AM, Burn MB, Smith KM, Incavo SJ. Early corrosion-related failure of the rejuvenate modular total hip replacement system. J Bone Joint Surg Am. 2014;96(6):481–7. Article is of importance as it confirmed the clinical, radiographic, and intra-operative findings of neck-stem mechanically assisted corrosion in the Stryker Rejuvenate femoral stem.
Silverton CD, Jacobs JJ, Devitt JW, Cooper HJ. Midterm results of a femoral stem with a modular neck design: clinical outcomes and metal ion analysis. J Arthroplasty. 2014;29(9):1768–73.
De Martino I, Assini JB, Elpers ME, Wright TM, Westrich GH. Corrosion and fretting of a modular hip system: a retrieval analysis of 60 rejuvenate stems. J Arthroplasty. 2015;30(8):1470–5.
Kop AM, Swarts E. Corrosion of a hip stem with a modular neck taper junction: a retrieval study of 16 cases. J Arthroplasty. 2009;24(7):1019–23.
Goldberg JR, Gilbert JL, Jacobs JJ, Bauer TW, Paprosky W, Leurgans S. A multicenter retrieval study of the taper interfaces of modular hip prostheses. Clin Orthop Relat Res. 2002;401:149–61.
United States Food and Drug Administration. Stryker Initiated Voluntary Product Recall of Modular-Neck Stems: Action Specific to Rejuvenate and ABG II Modular Neck Stems. http://www.fda.gov/safety/recalls/ucm311043.htm Accessed 16 September 2015
Bozic KJ, Rubash HE. The painful total hip replacement. Clin Orthop Relat Res. 2004;420:18–25.
Tower SS. Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report. J Bone Joint Surg Am. 2010;92(17):2847–51.
Bradbery SM, Wilkinson JM, Ferner RE. Systemic toxicity related to metal hip prostheses. Clin Toxicol (Phila). 2014;52(8):837–47.
Cooper HJ, Della Valle CJ, Berger RA, Tetrault M, Paprosky WG, Sporer SM, et al. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am. 2012;94(18):1655–61.
Yi PH, Cross MB, Moric M, Levine BR, Sporer SM, Paprosky WG, et al. Do serologic and synovial tests help diagnose infection in revision hip arthroplasty with metal-on-metal bearings or corrosion? Clin Orthop Relat Res. 2015;473(2):498–505. Article is of major importance as it outlines the diagnostic difficulty in differentiating PJI in patients with corroded modular neck femoral stems and makes a cutoff recommendations for cell counts indicative of PJI in these cases.
Pivec R, Meneghini RM, Hozack WJ, Westrich GH, Mont MA. Modular taper junction corrosion and failure: how to approach a recalled total hip arthroplasty implant. J Arthroplasty. 2014;29(1):1–6. This article is of importance as it provides an algorithm for evaluating patients presenting with corroded modular neck femoral stems.
Vundelinckx BJ, Verhelst LA, De Schepper J. Taper corrosion in modular hip prostheses: analysis of serum metal ions in 19 patients. J Arthroplasty. 2013;28(7):1218–23.
Walsh CP, Hubbard JC, Nessler JP, Markel DC. Revision of recalled modular neck rejuvenate and ABG femoral implants. J Arthroplasty. 2015;30(5):822–6.
Barlow BT, Assini J, Boles J, Lee YY, Westrich GH. Short-term metal ion trends following removal of recalled modular neck femoral stems. J Arthroplasty. 2015;30(7):1191–6. Article is of importance as it provides a timeline for serum ion normalization following revision of a corroded modular neck femoral stem.
Kwon YM, Fehring TK, Lombardi AV, Barnes CL, Cabanela ME, Jacobs JJ. Risk stratification algorithm for management of patients with dual modular taper total hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the Hip Society. J Arthroplasty. 2014;29(11):2060–4. Article is of major importance as it provides detailed outlines for stratifying patients with corroded modular neck femoral stems into low, medium, and high-risk patients. It also provides treatment and follow up recommendations for each of these risk classes.
Levine BR, Hsu AR, Skipor AK, Hallab NJ, Paprosky WG, Galante JO, et al. Ten-year outcome of serum metal ion levels after primary total hip arthroplasty: a concise follow-up of a previous report. J Bone Joint Surg Am. 2013;90(5):512–8. This article is of importance as it establishes expected normal serum ion values out to 10 years of follow up after receiving a modern modular head femoral stem.
Kwon YM. Cross-sectional imaging in evaluation of soft tissue reaction secondary to metal debris. J Arthroplasty. 2014;29(4):653–6. Article is of importance as it provides a good review of the available cross sectional imaging modalities and associated findings in the evaluation of the corroded modular femoral stem.
Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am. 2001;83-A(3):428–36.
Thyssen JP, Jakobsen SS, Engkilde K, Johansen JD, Søballe K, Menné T. The association between metal allergy, total hip arthroplasty, and revision. Acta Orthop. 2009;80(6):646–52.
Granchi D, Cenni E, Guinti A, Baldini N. Metal hypersensitivity testing in patients undergoing joint replacement: a systematic review. J Bone Joint Surg (Br). 2012;94(8):1126–34.
Mitchelson AJ, Wilson CJ, Mihalko WM, Grupp TM, Manning BT, Dennis DA, et al. Biomaterial hypersensitivity: is it real? Supportive evidence and approach considerations for metal allergic patients following total knee arthroplasty. Biomed Res Int. 2015;2015:137287.
Thomas P, Braathen LR, Dörig M, Auböck J, Nestle F, Werfel T, et al. Increased metal allergy with failed metal-on-metal hip arthroplasty and peri-implant T-lymphocytic inflammation. Allergy. 2009;64(8):1157–65.
Willer HG, Buchhorn GH, Fayyazi A, Flury R, Windler M, Köster G, et al. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study. J Bone Joint Surg Am. 2005;87(1):28–36.
Schalock PC, Menné T, Johansem JD, Taylor JS, Maiback HI, Lidén C, et al. Hypersensitivity reactions to metallic implants-diagnostic algorithm and suggested patch test series for clinical use. Contact Dermatitis. 2012;66(1):4–19.
Atanaskova Mesinkovska N, Tellez A, Molina L, Honari G, Sood A, Barsoum W, et al. The effect of patch testing on surgical practices and outcomes in orthopaedic patients with metal implants. Arch Dermatol. 2012;148(6):687–93.
Vermes C, Kuzsner J, Bárdos T, Than P. Prospective analysis of human leukocyte functional tests reveals metal sensitivity in patients with hip implant. J Orthop Surg Res. 2013;8:12.
Hallab NJ, Mikecz K, Jacobs JJ. A triple assay technique for the evaluation of metal-induced, delayed-type hypersensitivity responses in patients with or receiving total joint arthroplasty. J Biomed Mater Res. 2000;53(5):480–9.
Metal sensitivity testing and associated total joint outcomes. http://www.aaos.org/research/committee/biomed/BME_SE_2013.pdf. Accessed 30 September 2015.
Munro JT, Masri BA, Duncan CP, Garbuz DS. High complication rate after revision of large-head metal-on-metal total hip arthroplasty. Clin Orthop Relat Res. 2014;472(2):523–8. This article is of importance as it outlines the complications following metal-on-metal revision.
Wyles CC, Van Demark 3rd RE, Sierra RJ, Trousdale RT. High rate of infection after aseptic revision of failed metal-on-metal total hip arthroplasty. Clin Orthop Relat Res. 2014;472(2):509–16. This article is of importance as it outlines the complications following metal-on-metal revision.
Shah RP, Kamath AF, Saxena V, Garino JP. Steinman pin technique for the removal of well fixed femoral stems. J Arthroplasty. 2013;28(2):292–5. This article is of importance as it is the original description of the Steinman Pin Surgical Technique.
Younger TI, Bradford MS, Magnus RE, Paprosky WG. Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty. J Arthroplasty. 1995;10(3):329–38.
Mardones R, Gonzalez C, Cabanela ME, Trousdale RT, Berry DJ. Extended femoral osteotomy for revision of hip arthroplasty: results and complications. J Arthroplasty. 2005;20(1):79–83.
Miner TM, Momberger NG, Chong D, Paprosky WL. The extended trochanteric osteotomy in revision hip arthroplasty: a critical review of 166 cases at mean 3-year, 9-month follow up. J Arthroplasty. 2001;16(8 Suppl 1):188–94.
Cooper HJ. The local effects of metal corrosion in total hip arthroplasty. Orthop Clin N Am. 2014;45(1):9–18.
Yun AG, Padgett D, Pellicci P, Dorr LD. Constrained acetabular liners: mechanisms of failure. J Arthroplasty. 2005;20(4):536–41.
Noble PC, Durrani SK, Usrey MM, Mathis KB, Bardakos NV. Constrained cups appear incapable of meeting the demands of revision THA. Clin Orthop Relat Res. 2012;470(7):1907–16.
Plummer DR, Haughom BD, Della Valle CJ. Dual mobility in total hip arthroplasty. Orthop Clin N Am. 2014;45(1):1–8.
Lachiewicz PF, Watters TS. The use of dual-mobility components in total hip arthroplasty. J Am Acad Orthop Surg. 2012;20(8):481–6.
Philippot R, Boyer B, Farizon F. Intraprosthetic dislocation: a specific complication of the dual mobility system. Clin Orthop Relat Res. 2013;471(3):965–70.
Hailer NP, Weiss RJ, Stark A, Kärrholm J. Dual-mobility cups for revision due to instability are associated with a low rate of re-revision due to dislocation: 228 patients from the Swedish hip arthroplasty register. Acta Orthop. 2012;83(6):566–71.
Matsen Ko LJ, Pollag KE, Yoo JY, Sharkey PF. Serum metal ion levels following total hip arthroplasty with modular dual mobility components. J Arthroplasty. 2015.
Gascoyne TC, Dyrkacz RM, Turgeon TR, Burnell CD, Wyss UP, Brandt JM. Corrosion on the acetabular liner taper from retrieved modular metal-on-metal total hip replacements. J Arthroplasty. 2014;29(10):2049–52.
Conflict of interest
Mitchell C. Weiser reports that he is a member of the AAOS Biomedical Engineering Committee.
Darwin D. Chen reports personal fees from KCI Acelity, outside the submitted work.
Human and animal rights and informed consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Hip: Metal-on-Metal
About this article
Cite this article
Weiser, M.C., Chen, D.D. Revision for taper corrosion at the neck-body junction following total hip arthroplasty: pearls and pitfalls. Curr Rev Musculoskelet Med 9, 75–83 (2016). https://doi.org/10.1007/s12178-016-9322-2
- Modular neck
- Revision hip arthroplasty
- Adverse local tissue reaction