AIMS Head-taper corrosion is a cause of failure in total hip arthroplasty (THA). Recent reports have described an increasing number of V40 taper failures with adverse local tissue reaction (ALTR). However, the real incidence of V40 taper damage and its cause remain unknown. The aim of this study was to evaluate the long-term incidence of ALTR in a consecutive series of THAs using a V40 taper and identify potentially related factors. METHODS Between January 2006 and June 2007, a total of 121 patients underwent THA using either an uncemented (Accolade I, made of Ti12Mo6Zr2Fe; Stryker, USA) or a cemented (ABG II, made of cobalt-chrome-molybdenum (CoCrMo); Stryker) femoral component, both with a V40 taper (Stryker). Uncemented acetabular components (Trident; Stryker) with crosslinked polyethylene liners and CoCr femoral heads of 36 mm diameter were used in all patients. At a mean folllow-up of 10.8 years (SD 1.1), 94 patients (79%) were eligible for follow-up (six patients had already undergone a revision, 15 had died, and six were lost to follow-up). A total of 85 THAs in 80 patients (mean age 61 years (24 to 75); 47 (56%) were female) underwent clinical and radiological evaluation, including the measurement of whole blood levels of cobalt and chrome. Metal artifact reduction sequence MRI scans of the hip were performed in 71 patients. RESULTS A total of 20 ALTRs were identified on MRI, with an incidence of 26%. Patients with ALTR had significantly higher median Co levels compared with those without ALTR (2.96 μg/l (interquartile range (IQR) 1.35 to 4.98) vs 1.44 μg/l (IQR 0.79 to 2.5); p = 0.019). Radiological evidence of osteolysis was also significantly associated with ALTR (p = 0.014). Median Cr levels were not significantly higher in those with ALTR compared with those without one (0.97 μg/l (IQR 0.72 to 1.9) v 0.67 μg/l (IQR 0.5 to 1.19; p = 0.080). BMI, sex, age, type of femoral component, head length, the inclination of the acetabular component, and heterotopic ossification formation showed no significant relationship with ALTR. CONCLUSION Due to the high incidence of local ALTR in our cohort after more than ten years postoperatively, we recommend regular follow-up investigation even in asymptomatic patients with V40 taper and metal heads. As cobalt levels correlate with ALTR occurrence, routine metal ion screening and consecutive MRI investigation upon elevation could be discussed. Cite this article: Bone Joint J 2022;104-B(7):852-858.

中文翻译：

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采用 V40 锥度和 36 mm CoCr 头进行全髋关节置换术后由于头部锥度腐蚀导致的局部组织不良反应的发生率。

AIMS 头部锥形腐蚀是全髋关节置换术 (THA) 失败的原因。最近的报告描述了越来越多的 V40 锥度失败并伴有局部组织不良反应 (ALTR)。然而，V40锥度损坏的真实发生率及其原因仍然未知。本研究的目的是评估使用 V40 锥度的连续系列 THA 中 ALTR 的长期发病率，并确定潜在的相关因素。方法 2006 年 1 月至 2007 年 6 月期间，共有 121 名患者接受了非骨水泥（Accolade I，由 Ti12Mo6Zr2Fe 制成；Stryker，美国）或骨水泥（ABG II，由钴铬钼 (CoCrMo) 制成；Stryker ) 股骨组件，均采用 V40 锥度 (Stryker)。非骨水泥髋臼组件（Trident；Stryker) 与交联聚乙烯衬垫和直径 36 毫米的 CoCr 股骨头一起用于所有患者。在平均 10.8 年（SD 1.1）的随访中，94 名患者（79%）符合随访条件（6 名患者已经接受了翻修，15 人死亡，6 人失访）。80 名患者（平均年龄 61 岁（24 至 75 岁）；47 名（56%）为女性）的 85 例 THA 接受了临床和放射学评估，包括测量全血中钴和铬的水平。对 71 名患者进行了髋部金属伪影减少序列 MRI 扫描。结果 MRI 共发现 20 个 ALTR，发生率为 26%。与没有 ALTR 的患者相比，具有 ALTR 的患者的 Co 中位数显着升高（2.96 μg/l（四分位距 (IQR) 1.35 至 4.98）vs 1.44 μg/l（IQR 0.79 至 2.5）；p = 0.019）。骨溶解的放射学证据也与 ALTR 显着相关（p = 0.014）。与没有 ALTR 的患者相比，具有 ALTR 的中位 Cr 水平没有显着升高（0.97 μg/l（IQR 0.72 至 1.9）v 0.67 μg/l（IQR 0.5 至 1.19；p = 0.080）。BMI、性别、年龄、类型股骨假体、头长、髋臼假体倾斜度、异位骨化形成与ALTR无明显关系。甚至在 V40 锥度和金属头的无症状患者中进行调查。由于钴水平与 ALTR 的发生相关，因此可以讨论常规金属离子筛查和抬高后的连续 MRI 调查。引用这篇文章：骨关节 J 2022;104-B(7)：