Jeremy L. Gilbert

Current Concepts Review - Corrosion of Metal Orthopaedic Implants

In situ degradation of metal-alloy implants is undesirable for two reasons: the degradation process may decrease the structural integrity of the implant, and the release of degradation products may elicit an adverse biological reaction in the host. Degradation may result from electrochemical dissolution phenomena, wear, or a synergistic combination of the two. Electrochemical processes may include generalized corrosion, uniformly affecting the entire surface of the implant, and localized corrosion, affecting either regions of the device that are shielded from the tissue fluids (crevice corrosion) or seemingly random sites on the surface (pitting corrosion). Electrochemical and mechanical processes (for example, stress corrosion cracking, corrosion fatigue, and fretting corrosion) may interact, causing premature structural failure and accelerated release of metal particles and ions. The clinical importance of degradation of metal implants is evidenced by particulate corrosion and wear products in tissue surrounding the implant, which may ultimately result in a cascade of events leading to periprosthetic bone loss. Furthermore, many authors have reported increased concentrations of local and systemic trace metal in association with metal implants1,4,5,9-11,14,18,25,26,28,29,47,49-55,58,71,72,75-77,87,90,108-110. There also is a low but finite prevalence of corrosion-related fracture of the implant. This review focuses on electrochemical corrosion phenomena in alloys used for orthopaedic implants. A summary of basic electrochemistry is followed by a discussion of retrieval studies of the response of the implant to the host environment and the response of local tissue to implant corrosion products. The systemic implications of the release of metal particles also are presented. Finally, future directions in biomaterials research and development …

Composition and morphology of wear debris in failed uncemented total hip replacement

Interfacial membranes collected at revision from 11 failed uncemented Ti-alloy total hip replacements were examined. Particles in the membranes were characterised by electron microscopy, microchemical spectroscopy and particle size analysis. Most were polyethylene and had a mean size of 0.53 micron +/- 0.3. They were similar to the particles seen in the base resin used in the manufacture of the acetabular implants. Relatively few titanium particles were seen. Fragments of bone, stainless steel and silicate were found in small amounts. Most of the polyethylene particles were too small to be seen by light microscopy. Electron microscopy and spectroscopic techniques are required to provide an accurate description of this debris.

Migration of corrosion products from modular hip prostheses. Particle microanalysis and histopathological findings.

Migration of solid corrosion products from the modular head-neck junction of fifteen total hip replacements to the periprosthetic tissues was studied. The devices and tissues were recovered at the time of a revision procedure or at autopsy after a mean of sixty-four months (range, eight to ninety-seven months). The prostheses had a cobalt-chromium-alloy head coupled with a cobalt-chromium-alloy or a titanium-alloy stem. The solid corrosion product was identified by electron microprobe analysis and Fourier transform infrared microprobe spectroscopy as a chromium orthophosphate hydrate-rich material. The product was present at the junction of the modular head and neck and as particles within the periprosthetic tissues as early as eight months postoperatively. In several hips, it was also present on the polyethylene bearing surface. The particles in the tissues ranged in size from less than one to 500 micrometers. They were present within histiocytes or were surrounded by foreign-body giant cells in the pseudocapsule of the hip joint; in the membranes of the femoral bone-implant interface; and at sites of femoral endosteal erosions, with and without loosening of the femoral component.

Shear Strength of Composite Bonded to Er:YAG Laser-prepared Dentin

An Er:YAG laser coupled with a cooling stream of water effectively removes dental hard tissues. However, before such a system can be deemed clinically viable, some safety and efficacy issues must be addressed. We compared the bonding of composite to dentin following the preparation of the dentinal surface with either an Er:YAG laser (A = 2.94 pm) or a standard dental bur and with and without a subsequent acid-etching treatment. The crowns of extracted human molars were removed, revealing the underlying dentin. We removed an additional thickness of material with either a dental handpiece or an Er:YAG laser (350 mj/pulse at 6 Hz) by raster-scanning the samples under a fixed handpiece or laser. Comparable surface roughnesses were obtained. Several samples from each group received an acid-conditioning treatment. A cylinder of composite was bonded onto the prepared surfaces. The dentin-composite bond was then shear-stressed to failure on a universal testing apparatus. The results indicate that laser-irradiated samples had improved bond strengths compared with acid-etched and handpiece controls. SEM photographs of the surfaces show exposed tubules following the laser treatment; tubules could also be exposed with acid etching. We conclude that Er:YAG laser preparation of dentin leaves a suitable surface for strong bonding of an applied composite material.

Local and distant products from modularity.

In this study, the local and distant distribution of solid and soluble products of corrosion from the head and neck junction of modular femoral total hip prosthetic components were characterized. Particulate corrosion products from retrieved implants and surrounding tissues were analyzed. Serum transport and urinary excretion of metal was measured in correlation with the degree of corrosion at the head and neck junction. Particles of metal oxides, metal chlorides, and chromium phosphate corrosion products were identified on implants of 10 designs from 6 manufacturers. The most abundant solid corrosion product on the implant and within the periprosthetic tissues (size range, < 1-200 micrometers) was an amorphous chromium orthophosphate hydrate-rich material. Serum cobalt and urine chromium concentrations were elevated significantly in patients with implants that had moderate to severe corrosion in comparison with those with no to mild corrosion. Solid corrosion products from modular femoral stems may accelerate articular wear via a 3-body mechanism. Phagocytosable particles of these corrosion products may stimulate macrophage-mediated periprosthetic bone loss. Systemic dissemination of metallic corrosion products raises the issue of systemic toxicity; however, no overt evidence of metal toxicity was observed in this study.

Intergranular corrosion-fatigue failure of cobalt-alloy femoral stems : a failure analysis of two implants

Two modular hip implants with a cobalt-alloy head and a cobalt-alloy stem were retrieved after a fracture had occurred in the neck region of the femoral component, eighty-five and seventy months after implantation. Both implants failed less than one millimeter distal to the taper junction between the head and the stem (outside of the taper). The fracture surfaces of the implant were investigated with the use of scanning electron microscopy, to determine the nature of the failure process. The fractures occurred at the grain boundaries of the microstructure and appeared to be the result of three factors: porosity at the grain boundaries; intergranular corrosive attack, initiated both at the head-neck taper and at the free surface; and cyclic fatigue-loading of the stem. The corrosive attack of the free surface was initiated, in part, by the egression of surface grains and by the ingression of fluid into the intergranular regions. Sectioned surfaces showed extensive intergranular corrosive attack in the prosthetic neck localized in the region of the head-neck taper junction and penetrating deeply into the microstructure.

Do Ceramic Femoral Heads Reduce Taper Fretting Corrosion in Hip Arthroplasty? A Retrieval Study

BackgroundPrevious studies regarding modular head-neck taper corrosion were largely based on cobalt chrome (CoCr) alloy femoral heads. Less is known about head-neck taper corrosion with ceramic femoral heads.Questions/purposesWe asked (1) whether ceramic heads resulted in less taper corrosion than CoCr heads; (2) what device and patient factors influence taper fretting corrosion; and (3) whether the mechanism of taper fretting corrosion in ceramic heads differs from that in CoCr heads.MethodsOne hundred femoral head-stem pairs were analyzed for evidence of fretting and corrosion using a visual scoring technique based on the severity and extent of fretting and corrosion damage observed at the taper. A matched cohort design was used in which 50 ceramic head-stem pairs were matched with 50 CoCr head-stem pairs based on implantation time, lateral offset, stem design, and flexural rigidity.ResultsFretting and corrosion scores were lower for the stems in the ceramic head cohort (p = 0.03). Stem alloy (p = 0.004) and lower stem flexural rigidity (Spearman’s rho = −0.32, p = 0.02) predicted stem fretting and corrosion damage in the ceramic head cohort but not in the metal head cohort. The mechanism of mechanically assisted crevice corrosion was similar in both cohorts although in the case of ceramic femoral heads, only one of the two surfaces (the male metal taper) engaged in the oxide abrasion and repassivation process.ConclusionsThe results suggest that by using a ceramic femoral head, CoCr fretting and corrosion from the modular head-neck taper may be mitigated but not eliminated.Clinical RelevanceThe findings of this study support further study of the role of ceramic heads in potentially reducing femoral taper corrosion.

IN VIVO SEVERE CORROSION AND HYDROGEN EMBRITTLEMENT OF RETRIEVED MODULAR BODY TITANIUM ALLOY HIP-IMPLANTS

Titanium alloys are widely used in total-joint replacements due to a combination of outstanding mechanical properties, biocompatibility, passivity, and corrosion resistance. Nevertheless, retrieval studies have pointed out that these materials can be subjected to localized or general corrosion in modular interfaces when mechanical abrasion of the oxide film (fretting) occurs. Modularity adds large crevice environments, which are subject to micromotion between contacting interfaces and differential aeration of the surface. Titanium alloys are also known to be susceptible to hydrogen absorption, which can induce precipitation of hydrides and subsequent brittle failure. In this work, the surface of three designs of retrieved hip-implants with Ti-6Al-4V/Ti-6Al-4V modular taper interfaces in the stem were investigated for evidence of severe corrosion and precipitation of brittle hydrides during fretting-crevice corrosion in the modular connections. The devices were retrieved from patients and studied by means of scanning electron microscopy (SEM), X-ray diffraction (XRD), and chemical analysis. The surface qualitative investigation revealed severe corrosion attack in the mating interfaces with evidence of etching, pitting, delamination, and surface cracking. In vivo hydrogen embrittlement was shown to be a mechanism of degradation in modular connections resulting from electrochemical reactions induced in the crevice environment of the tapers during fretting-crevice corrosion.

The electrochemical and mechanical behavior of passivated and TiN/AlN-coated CoCrMo and Ti6Al4V alloys.

The mechanical and electrochemical behavior of the surface oxides of CoCrMo and Ti6Al4V alloys during fracture and repassivation play an important role in the corrosion of the taper interfaces of modular hip implants. This behavior was investigated in one group of CoCrMo and Ti6Al4V alloy samples passivated with nitric acid and another group coated with a novel TiN/AlN coating. The effects of mechanical load and sample potential on peak currents and time constants resulting from fracture of the surface oxide or coating, and the effects of mechanical load on scratch depth were investigated to determine the mechanical and electrochemical properties of the oxides or coating. The polarization behavior of the samples after fracture of the oxide or coating was also investigated. CoCrMo had a stronger surface oxide and higher interfacial adhesion strength, making it more resistant to fracture than Ti6Al4V. If undisturbed, the oxide on the surface of Ti6Al4V significantly reduced dissolution currents at a wider range of potentials than CoCrMo, making Ti6Al4V more resistant to corrosion. The TiN/AlN coating had a higher hardness and modulus of elasticity than CoCrMo and Ti6Al4V. It was much less susceptible to fracture, had a higher interfacial adhesion strength, and was a better barrier to ionic diffusion than the surface oxides on CoCrMo and Ti6Al4V. The coating provided increased corrosion and fretting resistance to the substrate alloys.

Is Increased Modularity Associated With Increased Fretting and Corrosion Damage in Metal-On-Metal Total Hip Arthroplasty Devices?: A Retrieval Study

This retrieval study documents taper damage at modular interfaces in retrieved MOM THA systems and investigates if increased modularity is associated with increased fretting and corrosion. One hundred thirty-four (134) heads and 60 stems (41 modular necks) of 8 different bearing designs (5 manufacturers) were analyzed. Damage at the shell-liner interface of 18 modular CoCr acetabular liners and the corresponding 11 acetabular shells was also evaluated. The results of this study support the hypothesis that fretting and corrosion damage occurs at a variety of modular component interfaces in contemporary MOM THAs. We also found that modularity of the femoral stem was associated with increased damage at the head. An analysis of component and patient variables revealed that dissimilar alloy pairing, larger head sizes, increased medio-lateral offsets and longer neck moment arms were all associated with increased taper damage at the modular interfaces.