Surgical options for addressing taper corrosion
When taper joint corrosion is identified as the root cause of issues such as pain, swelling, and instability, revision is an option. However, surgeons should keep in mind that numerous asymptomatic cases have been documented. We share some considerations to help guide surgical intervention. While all surgery carries inherent risk, corrosion-related tissue damage, when severe, is associated with increased complication rates, making the case for early intervention.
Identifying corrosion as the primary source of painful symptoms in modular total hip replacement patients is a process of elimination . Comprehensive presurgical evaluation that includes clinical examination, serum metal testing, and imaging can be helpful in making a diagnosis [1, 2] [See Part II of this article series]. For those that are asymptomatic, implant failure is usually the first indication of a problem, and adverse local tissue reaction (ALTR) due to corrosion can be unexpectedly encountered during revision .
Read an interview: AO Recon spoke with Moussa Hamadouche, an orthopedic surgeon and professor, about key points to consider when diagnosing taper corrosion. He raises a question about the role of metal sensitivity in patients as a factor compounding adverse local tissue reactions.
The importance of presurgical planning
Developed for the management of patients with metal-on-metal total hip implants (MoM THA), the risk stratification algorithm from Kwon  has been suggested as a useful aid in revision decision making for this patient population  (see Tables 1, 2, 3).
Once it has been determined that corrosion and associated tissue damage will be encountered during a revision, it is important to systematically plan for the procedure. Conducting a thorough evaluation of patient characteristics, taking into consideration the previous approach and implants used, stocking a supply of implant components that will and may be required, as well as anticipating soft tissue and/or bone damage is suggested .
Weiser and Chen  also advise surgeons to be well versed in techniques and procedures for revision and have a variety of revision instruments on hand, such as: a manufacturer-specific stem extraction device, slap hammer, vice grips, high-speed pencil tip bur, flexible osteotomes, broad osteotomes, bipolar wound sealer, cerclage cables, and standard hip revision instruments. Additionally, they list acetabular explant devices, high-speed burs, and round acetabular osteotomes as helpful tools. Patients, particularly those with recalled implants, may require the return of explanted components for analysis and litigation purposes. This request should be clearly communicated to the surgical team.
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- Open patient communication
- Intraoperative considerations
- Should femoral stems be retained?
- Don’t mismatch the components
- More research to guide decision-making
- Interview with Moussa Hamadouche
- Diagnostic indicators
- Affected patients
- Role of implants
- Revision steps
- Educational measures
Additional AO resources
Access videos, tools, and other assets to learn more about this topic.
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This series of articles was created with the support of the following specialists (in alphabetical order):
Cochin University Hospital
Hamburg University of Technology
Charité—University Medicine Berlin
This issue was created by Word+Vision Media Productions, Switzerland
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