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      Profound Trunnion Wear Resulting in Femoral Head-Neck Dissociation in Total Hip Arthroplasty

      case-report
      Author(s): 1 , , 2 , 3 , 2 , 3 , 4
      Publication date (Electronic):
      Journal: Case Reports in Orthopedics
      Publisher: Hindawi

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          Abstract

          We describe a case of aseptic failure with profound femoral stem trunnion wear and femoral head dissociation nine years after initial primary total hip arthroplasty (THA) with the Stryker Accolade total hip arthroplasty system. Current guidelines for postoperative care and follow-up after THAs as potential intervention points for early detection of prosthetic joint failure are also reviewed.

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          Trunnionosis in total hip arthroplasty: a review

          Jaydev Mistry, Morad Chughtai, Randa Elmallah … (2016)
          Trunnionosis is defined as wear of the femoral head–neck interface and has recently been acknowledged as a growing cause of total hip arthroplasty failure. Some studies have reported that it accounts for up to 3 % of all revisions. The exact cause of trunnionosis is currently unknown; however, postulated etiologies include modular junction wear, corrosion damage, and metal ion release. Additionally, implant design and trunnion geometries may contribute to the progression of component failure. In order to aid in our understanding of this phenomenon, our aim was to present the current literature on (1) the effect of femoral head size on trunnionosis, (2) the effect of trunnion design on trunnionosis, (3) localized biological reactions associated with trunnionosis, and (4) gross trunnion failures. It is hoped that this will encourage further research and interest aimed at minimizing this complication.
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            The influence of head size on corrosion and fretting behaviour at the head-neck interface of artificial hip joints.

            Richard M R Dyrkacz, M. Brandt, Joseph Ojo … (2013)
            The primary goal of this study was to determine if head size affects corrosion and fretting behaviour at the head-neck taper interface of modular hip prostheses. Seventy-four implants were retrieved that featured either a 28 mm or a 36 mm head with a metal-on-polyethylene articulation. The bore of the heads and the neck of the stems were divided into eight regions each and graded by three observers for corrosion and fretting damage separately using modified criteria as reported in the literature. The 36 mm head size featured a significant difference in the corrosion head scores (p=0.022) in comparison to the 28 mm heads. This may be attributed to a greater torque acting along the taper interface due to activities of daily living. Copyright © 2013 Elsevier Inc. All rights reserved.
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              High failure rates with a large-diameter hybrid metal-on-metal total hip replacement: clinical, radiological and retrieval analysis.

              K J Millington, B J R F Bolland, D Langton … (2011)
              This study reports the mid-term results of a large-bearing hybrid metal-on-metal total hip replacement in 199 hips (185 patients) with a mean follow-up of 62 months (32 to 83). Two patients died of unrelated causes and 13 were lost to follow-up. In all, 17 hips (8.5%) have undergone revision, and a further 14 are awaiting surgery. All revisions were symptomatic. Of the revision cases, 14 hips showed evidence of adverse reactions to metal debris. The patients revised or awaiting revision had significantly higher whole blood cobalt ion levels (p = 0.001), but no significant difference in acetabular component size or position compared with the unrevised patients. Wear analysis (n = 5) showed increased wear at the trunnion-head interface, normal levels of wear at the articulating surfaces and evidence of corrosion on the surface of the stem. The cumulative survival rate, with revision for any reason, was 92.4% (95% confidence interval 87.4 to 95.4) at five years. Including those awaiting surgery, the revision rate would be 15.1% with a cumulative survival at five years of 89.6% (95% confidence interval 83.9 to 93.4). This hybrid metal-on-metal total hip replacement series has shown an unacceptably high rate of failure, with evidence of high wear at the trunnion-head interface and passive corrosion of the stem surface. This raises concerns about the use of large heads on conventional 12/14 tapers.
              Article 0 comments Cited 37 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Saif Shamshoon:
                ORCID: http://orcid.org/0000-0002-0872-7795
                Journal
                Journal ID (nlm-ta): Case Rep Orthop
                Journal ID (iso-abbrev): Case Rep Orthop
                Journal ID (publisher-id): CRIOR
                Title: Case Reports in Orthopedics
                Publisher: Hindawi
                ISSN (Print): 2090-6749
                ISSN (Electronic): 2090-6757
                Publication date Collection: 2018
                Publication date (Electronic): 23 August 2018
                Volume: 2018
                Electronic Location Identifier: 1534572
                Affiliations
                1Faculty of Health Sciences, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
                2Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
                3Hamilton Health Sciences, Juravinski Hospital, Hamilton, Ontario, Canada
                4Hamilton Arthroplasty Group, Hamilton Health Sciences, Juravinski Hospital, Hamilton, Ontario, Canada
                Author notes

                Academic Editor: Akio Sakamoto

                Author information
                http://orcid.org/0000-0002-0872-7795
                Article
                DOI: 10.1155/2018/1534572
                PMC ID: 6126067
                SO-VID: 2fb39bfa-188f-4b61-8778-71e887bf1592
                Copyright © Copyright © 2018 Saif Shamshoon et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 7 June 2018
                Date accepted : 12 August 2018
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Orthopedics
                Data availability:
                ScienceOpen disciplines: Orthopedics

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