Hip Instability Leading to Metallosis, Polyethylene Wear, and Failure of an Oxinium Femoral Head: A Case Report and Review of Literature

Abstract

Oxinium is a zirconium metal alloy with an oxidized (ceramicized) surface that aims to mimic the superior wear properties of a ceramic femoral head while maintaining the high strength of metal-bearing surfaces. There are several reports that illustrate the wear and/or failure of Oxinium femoral heads following abnormal head contact with metal cup, with only a few studies reporting on the occurrence of metallosis. We present a case of metallosis and failure of Oxinium femoral head following two incidents of hip instability and one closed reduction. Successful revision was performed with cemented cup and metal femoral head, with 68 months of follow-up. We aimed to highlight the importance of achieving stable and well-oriented hip components when using Oxinium-bearing surfaces and to present a short literature review regarding the wear of oxidized zirconium-bearing surfaces in hip arthroplasty.

Keywords

Oxinium - metallosis - total hip arthroplasty - wear - instability

Publication History

Received: 02 April 2021

Accepted: 02 August 2021

Article published online:
17 September 2021

• References

• 1 Good V, Ries M, Barrack RL, Widding K, Hunter G, Heuer D. Reduced wear with oxidized zirconium femoral heads. J Bone Joint Surg Am 2003; 85-A (Suppl. 04) 105-110
• 2 Patel AM, Spector M. Tribological evaluation of oxidized zirconium using an articular cartilage counterface: a novel material for potential use in hemiarthroplasty. Biomaterials 1997; 18 (05) 441-447
• 3 Karidakis GK, Karachalios T. Oxidized zirconium head on crosslinked polyethylene liner in total hip arthroplasty: a 7- to 12-year in vivo comparative wear study. Clin Orthop Relat Res 2015; 473 (12) 3836-3845
• 4 Zaoui A, Hage SE, Langlois J, Scemama C, Courpied JP, Hamadouche M. Do oxidized zirconium femoral heads reduce polyethylene wear in cemented THAs? A blinded randomized clinical trial. Clin Orthop Relat Res 2015; 473 (12) 3822-3828
• 5 Petis SM, Vasarhelyi EM, Lanting BA. et al. Mid-term survivorship and clinical outcomes of cobalt-chrome and oxidized zirconium on highly crosslinked polyethylene. Can J Surg 2016; 59 (01) 48-53
• 6 Evangelista GT, Fulkerson E, Kummer F, Di Cesare PE. Surface damage to an Oxinium femoral head prosthesis after dislocation. J Bone Joint Surg Br 2007; 89 (04) 535-537
• 7 Kop AM, Whitewood C, Johnston DJ. Damage of oxinium femoral heads subsequent to hip arthroplasty dislocation three retrieval case studies. J Arthroplasty 2007; 22 (05) 775-779
• 8 Bragdon CR, Wannomae KK, Lozynsky A, Micheli B, Malchau H. The effect of in vivo damage of Oxinium femoral heads on the wear of highly cross-linked polyethylene. Accessed August 16, 2021 at: www.ors.org/Transactions/55/2337.pdf
• 9 Jaffe WL, Strauss EJ, Cardinale M, Herrera L, Kummer FJ. Surface oxidized zirconium total hip arthroplasty head damage due to closed reduction effects on polyethylene wear. J Arthroplasty 2009; 24 (06) 898-902
• 10 McCalden RW, Charron KD, Davidson RD, Teeter MG, Holdsworth DW. Damage of an Oxinium femoral head and polyethylene liner following ‘routine’ total hip replacement. J Bone Joint Surg Br 2011; 93 (03) 409-413
• 11 Tribe H, Malek S, Stammers J, Ranawat V, Skinner JA. Advanced wear of an Oxinium femoral head implant following polyethylene liner dislocation. Ann R Coll Surg Engl 2013; 95 (08) e133-e135
• 12 Gibon E, Scemama C, David B, Hamadouche M. Oxinium femoral head damage generated by a metallic foreign body within the polyethylene cup following recurrent dislocation episodes. Orthop Traumatol Surg Res 2013; 99 (07) 865-869
• 13 Moussa ME, Esposito CI, Elpers ME, Wright TM, Padgett DE. Hip dislocation increases roughness of oxidized zirconium femoral heads in total hip arthroplasty: an analysis of 59 retrievals. J Arthroplasty 2015; 30 (04) 713-717
• 14 Gkouliopoulou E, Agathangelidis F, Vampertzis T, Ntovas T. Severe metallosis following oxidised zirconium wear in total hip arthroplasty. BMJ Case Rep 2016; 2016: bcr2016218025
• 15 Zou AH, Novikov D, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM. Liner dissociation leading to catastrophic failure of an Oxinium femoral head. Arthroplast Today 2018; 5 (01) 21-25
• 16 Bonnheim NB, Van Citters DW, Ries MD, Pruitt LA. Oxidized zirconium components maintain a smooth articular surface except following hip dislocation. J Arthroplasty 2021; 36 (04) 1437-1444
• 17 Carli AV, Patel AR, Cross MB. et al. Long-term performance of oxidized zirconium on conventional and highly cross-linked polyethylene in total hip arthroplasty. SICOT J 2020; 6: 10
• 18 Pospischill M, Knahr K. Strategies for head and inlay exchange in revision hip arthroplasty. Int Orthop 2011; 35 (02) 261-265
• 19 Mahmoud AN, Sundberg M, Flivik G. Comparable results with porous metal augments in combination with either cemented or uncemented cups in revision hip arthroplasty: an analysis of one hundred forty-seven revisions at a mean of five years. J Arthroplasty 2017; 32 (05) 1612-1617