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Taper Corrosion and Adverse Local Tissue Reactions in Patients with a Modular Knee Prosthesis

Christiner, Tom, MBBS1,2; Pabbruwe, Moreica B., BEng, PhD1; Kop, Alan M., PhD, MSc, PostGradDip, BAppSc1; Parry, Jeremy, MBBS, BSc2; Clark, Gavin, MBBS, FRACS(Ortho)3; Collopy, Dermot, MBBS, FRACS(Ortho)3

doi: 10.2106/JBJS.OA.18.00019
Scientific Articles: PDF Only

Background: Corrosion has been documented in modular knee implants, but it has not been related to negative patient outcomes. We performed an observational retrieval investigation of 13 Stryker Triathlon TS modular knee implants, 3 of which were revised because of osteolysis and adverse local tissue reactions secondary to fretting corrosion at the modular junctions.

Methods: Modular surfaces were examined for the presence and severity of corrosion, and factors that may influence the development of corrosion were investigated. Scanning electron microscopy and energy-dispersive x-ray spectroscopy were performed to evaluate implants with severe corrosion, and tissue samples were sent for histopathological analysis.

Results: Mild to severe corrosion was present in association with 62% of modular tibial components and 75% of modular femoral components. Although tibial corrosion was less prevalent than femoral corrosion, it occurred earlier and with greater severity. Scanning electron microscopy and energy-dispersive x-ray spectroscopy demonstrated the appearances of fretting and corrosion of the modular junctions. Histopathological analysis of specimens from the 3 patients with adverse local tissue reactions demonstrated severe reactions to metal debris, including 1 reaction that was consistent with an aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL).

Conclusions: To our knowledge, ALVAL and pseudotumors have not previously been reported secondary to corrosion of modular knee replacements. The threaded taper design and the release of cobalt-chromium ions and/or debris are implicated in the occurrence of the adverse local tissue reactions, osteolysis, and soft-tissue damage that we observed in our investigation. Clinicians should be aware of this possible complication associated with modular knee implants.

Clinical Relevance: This article should raise clinician awareness of adverse local tissue reactions secondary to corrosion, potentially resulting in earlier recognition of this complication.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

1Centre for Implant Technology and Retrieval Analysis (CITRA), Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Australia

2Anatomical Pathology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Murdoch, Australia

3Perth Hip and Knee Clinic, Subiaco, Australia

E-mail address for T. Christiner:

Investigation performed at Centre for Implant Technology and Retrieval Analysis (CITRA), Perth, Australia.

Disclosure: No external funding was received in support of the current study. On the Disclosure of Potential Conflicts of Interest forms, which are provided with the online version of the article, one or more of the authors checked “yes” to indicate that the author had a relevant financial relationship in the biomedical arena outside the submitted work (

© 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The Journal of Bone and Joint Surgery, Incorporated.