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Symptomatic Aseptic Hydrogen Pneumarthrosis as a Sign of Crevice Corrosion Following Total Hip Arthroplasty with a Modular NeckA Case Report
Alexander E. Weber, MD1; Jack G. Skendzel, MD1; David L. Waxman, MD2; John D. Blaha, MD1
1 Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, SPC 5328, 1500 East Medical Center Drive, Ann Arbor, MI 48109. E-mail address for A.E. Weber: alexweb@med.umich.edu
2 West Virginia Hip and Knee Replacement Center, 527 Medical Park Drive, Bridgeport, West Virginia 26330
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Investigation performed at the Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, and the West Virginia Hip and Knee Replacement Center, Bridgeport, West Virginia

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Jul 24;3(3):e76 1-6. doi: 10.2106/JBJS.CC.L.00261
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Modular neck components in total hip arthroplasty enhance intraoperative flexibility and ease of revision. Femoral modular components allow alteration of neck length, version, and offset once the femoral stem has been implanted, leading to purported postoperative advantages in reduced wear rate1, enhanced hip stability2,3, increased range of motion, and decreased risk of dislocation3-5. Use of the modular neck also introduces an additional component interface between the neck and the stem, resulting in a large crevice with an angular geometric mismatch between the taper on the modular neck and the sleeve of the proximal femoral neck, which leaves the interface susceptible to micromotion6-10. Over time, micromotion removes the passivation layer on the implants and leads to fretting corrosion, which can be superimposed by crevice corrosion, especially in titanium implants11-13. Retrieval studies have documented the complications of this pathway, including failure to disassemble the neck from the stem14 and implant failure via fracture at the neck-stem interface15-17.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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