Taper Failure After Large-Diameter Metal-on-Metal Total Hip Arthroplasty

The use of metal-on-metal bearing surfaces for total hip arthroplasty increased dramatically in the past decade for a variety of reasons, including the advantage of using larger-diameter femoral heads to reduce instability. However, recent research suggesting negative outcomes and high failure rates associated with some of these implants has decreased their use. Further, the use of larger-diameter femoral heads on relatively small femoral neck tapers has caused concern about localized corrosion at this junction, particularly with varus femoral alignment and longer femoral neck and head lengths. Although the advent of modular components offers the surgeon greater intraoperative flexibility, this modularity may prove to be a weak link when coupled with large-diameter femoral heads. This report describes a patient with a history of bilateral metal-on-metal total hip arthroplasty complicated by failure of the right hip as a result of fretting and mechanically assisted crevice corrosion. Notching of the femoral neck and head dissociation occurred 10 years after the primary procedure. The authors describe the patient's presenting symptoms, the possible etiology of the catastrophic failure, and the method of treatment and provide a brief review of metal-on-metal implants that may shed some light on the complications in this case.