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Severe Metal-induced Osteolysis Many Years After Unipolar Hip Endoprosthesis

  • Case Report
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Modularity of the femoral head-neck junction provides increased intraoperative flexibility to the surgeon. Complications of this modularity include damage to the trunnion, with subsequent bone and/or soft tissue loss from adverse reactions to metal debris.

Case Description

We describe two cases of severe metal-induced osteolysis and soft tissue damage requiring revision 10 and 13 years following implantation of a unipolar endoprosthesis. Damage to the trunnion resulted in severe acetabular and trochanteric osteolysis and soft tissue loss requiring complex revision surgery.

Literature Review

Several reports have shown the trunnion, the head-neck interface, and the neck-stem couple as the causes of this early failure secondary to metal ion release from mechanical fretting corrosion or from crevice corrosion at these modular interfaces. These reports have been in association with a total hip prosthesis rather than a unipolar endoprosthesis. Revision of a unipolar endoprosthesis is most commonly attributable to stem loosening or acetabular erosion from the large femoral head articulating on the host acetabular cartilage and not owing to failure of the trunnion.

Purposes and Clinical Relevance

Trunnion damage resulting in a severe reaction to metal debris with acetabular osteolysis, erosion of the greater trochanter, and loss of the abductor mechanism can occur years after implantation of a cementless unipolar endoprosthesis. This raises questions regarding long-term safety of the modular interface of a contemporary cementless stem and a large-diameter unipolar head. We recommend long-term followup of patients with a unipolar endoprosthesis as early recognition and treatment are required to avoid a potentially complex revision.

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Fig. 1A–E
Fig. 2A–C

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Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, McGill University, Montreal, QC, Canada

    Matthew A. Mann MD & Michael Tanzer MD

  2. McGill University Health Centre, 1650 Cedar Avenue #B5.159, Montreal, QC, H3G 1A4, Canada

    Michael Tanzer MD

  3. McGill University, Montreal, QC, Canada

    Dylan Tanzer DEC

Authors
  1. Matthew A. Mann MD
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  2. Dylan Tanzer DEC
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  3. Michael Tanzer MD
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Corresponding author

Correspondence to Michael Tanzer MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the reporting of this case report, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Mann, M.A., Tanzer, D. & Tanzer, M. Severe Metal-induced Osteolysis Many Years After Unipolar Hip Endoprosthesis. Clin Orthop Relat Res 471, 2078–2082 (2013). https://doi.org/10.1007/s11999-012-2780-y

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  • DOI: https://doi.org/10.1007/s11999-012-2780-y

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