Femoral Head-Trunnion Dissociation in Metal-on-Polyethylene Total Hip Arthroplasty – A Unique Case Report
Keywords:Hip arthroplasty, trunnion failure
Background: Gross trunnion failure (GTF) after total hip arthroplasty is a rare complication and has only been reported in a few case series. Some of the associated risk factors have been described in the literature and include larger femoral heads, greater offset, and increased BMI. Despite this, the mechanism behind GTF is poorly understood and early diagnosis and treatment continues to be challenging.
Case Presentation: We present the case of complete femoral head and trunnion dissociation in a 63 year-old female nine years after total hip arthroplasty. Unique to this case is the lack of classic patient and implant risk factors for GTF along with the acute onset nearly nine years after implantation.
Discussion: This case presentation highlights the fact that the contributing factors and mechanism behind GTF continue to be poorly understood. There is a need for future research to help better understand this phenomenon and to help potentially identify those at risk for GTF.
Cooper HJ, Della Valle CJ, Berger RA, Tetreault M, Paprosky WG, Sporer SM,Jacobs JJ. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am. 2012 Sep 19;94(18): 1655-61.
Banerjee S, Cherian JJ, Bono JV, Kurtz SM, Geesink R, Meneghini RM, Delanois RE, Mont MA. Gross trunnion failure after primary total hip arthroplasty. J Arthroplasty. 2015 Apr;30(4):641-8. Epub 2014 Nov 26.
Jacobs JJ, Cooper HJ, Urban RM, Wixson RL, Della Valle CJ. What do we know about taper corrosion in total hip arthroplasty? J Arthroplasty. 2014 Apr;29(4): 668-9. Epub 2014 Feb 18.
Gilbert JL, Mehta M, Pinder B. Fretting crevice corrosion of stainless steel stem-CoCr femoral head connections: comparisons of materials, initial moisture, and offset length. J Biomed Mater Res B Appl Biomater. 2009 Jan; 88(1):162-73.
Matsen Ko L, Chen AF, Deirmengian GK, Hozack WJ, Sharkey PF. Catastrophic Femoral Head-Stem Trunnion Dissociation Secondary to Corrosion. J Bone Joint Surg Am. 2016 Aug 17;98(16):1400-4.
Kiran M, Boscainos PJ. Adverse reactions to metal debris in metal-on-polyethylene total hip arthroplasty using a titanium-molybdenum-zirconium-iron alloy stem. J Arthroplasty. 2015 Feb;30(2):277-81. Epub 2014 Oct 30.
Goldberg JR, Gilbert JL, Jacobs JJ, et al. A multicenter retrieval study of the taper interface of modular hip prostheses. Clin Orthop Relat Res 2002;401:149.
Panagiotidou A, Meswania J, Hua J, Muirhead-Allwood S, Hart A, Blunn G. Enhanced wear and corrosion in modular tapers in total hip replacement is associated with the contact area and surface topography. J Orthop Res. 2013 Dec;31(12):2032-9. Epub 2013 Aug 21.
Higgs GB, MacDonald DW, Gilbert JL, Rimnac CM, Kurtz SM. Does Taper Size Have an Effect on Taper Damage in Retrieved Metal-on-Polyethylene Total Hip Devices? J Arthroplasty. 2016 Sep;(3):277-81. Epub 2016 Jul 6.
Cook, R.B., et al., Pseudotumour formation due to tribocorrosion at the taper interface of large diameter metal on polymer modular total hip replacements. J Arthroplasty, 2013. 28(8): p. 1430-6.
Walker, P., Campbell, D., Della Torre, P., Brazil, D., McTighe, T. Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series. Reconstructive Review. Volume 6 (Number 3): September 2016
How to Cite
Copyright (c) 2018 Nick N. Patel, George N. Guild, Greg A. Erens
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright and License Agreement:
Authors who publish with the Reconstructive Review agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work. Reconstructive Review follows the Creative Commons Attribution-NonCommercial CC BY-NC. This license allows anyone to download works, build upon the material, and share them with others for non-commercial purposes as long as they credit the senior author, Reconstructive Review, and the Joint Implant Surgery & Research Foundation (JISRF). An example credit would be: "Courtesy of (senior author's name), Reconstructive Review, JISRF, Chagrin Falls, Ohio". While works can be downloaded and shared they cannot be used commercially.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.