Abstract
Though rare, there are documented failures of femoral prosthesis due to corrosion of the head–neck interface in total hip arthroplasty (THA), a phenomenon known as trunnionosis. This wear can result in metallosis, whereby metal debris scatters the surrounding soft tissues. We present on a 58-year-old female who presented with increase in hip and back pain 10 years following right THA using a metal-on-polyethylene construct with a large femoral head (44 mm). Aspiration withdrew metallic fluid, and intraoperative findings showed corrosion of the head–neck taper with surrounding metallosis and pseudocapsule formation. Despite advances in THA design, corrosion and wear between components still exists and may be cause for failure. We present on both the subtle clinical findings and the recommended workup when suspicion is high for trunnionosis, metallosis, or wear, ideally with identification prior to catastrophic failure such as component dislocation or fracture as previously reported.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Banerjee S, Cherian JJ, Bono JV, Kurtz SM, Geesink R, Meneghini RM (2015) Gross trunnion failure after primary total hip arthroplasty. J Arthroplasty 30(4):641–648. https://doi.org/10.1016/j.arth.2014.11.023
Cooper HJ, Urban RM, Wixson RL, Meneghini RM, Jacobs JJ (2013) Adverse local tissue reaction arising from corrosion at the femoral neck-body junction in a dual-taper stem with a cobalt-chromium modular neck. J Bone Joint Surg Am 95(10):865–872. https://doi.org/10.2106/JBJS.L.01042
Pourzal R, Lundberg HJ, Hall DJ, Jacobs JJ (2018) What factors drive taper corrosion? J Arthroplasty 1:1–2. https://doi.org/10.1016/j.arth.2018.03.055
Tan SC, Teeter MG, Del Balso C, Howard JL, Lanting BA (2015) Effect of taper design on trunnionosis in metal on polyethylene total hip arthroplasty. J Arthroplasty 30(7):1269–1272. https://doi.org/10.1016/j.arth.2015.02.031
Hussey DK, McGrory BJ (2017) Ten-year cross-sectional study of mechanically assisted crevice corrosion in 1352 consecutive patients with metal-on-polyethylene total hip arthroplasty. J Arthroplasty 32(8):2546–2551. https://doi.org/10.1016/j.arth.2017.03.020
Cooper HJ, Della Valle CJ, Berger RA, Tetreault M, Paprosky WG, Sporer SM (2012) Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am 94(18):1655–1661. https://doi.org/10.2106/JBJS.K.01352
Morlock M, Bunte D, Guhrs J, Bishop N (2017) Corrosion of the head-stem taper junction-are we on the verge of an epidemic? Review article. HSS J 13(1):42–49. https://doi.org/10.1007/s11420-016-9526-4
Morlock MM (2015) The taper disaster—how could it happen? Hip Int 25(4):339–346. https://doi.org/10.5301/hipint.5000269
Matsen Ko L, Chen AF, Deirmengian GK, Hozack WJ, Sharkey PF (2016) Catastrophic femoral head-stem trunnion dissociation secondary to corrosion. J Bone Joint Surg Am 98(16):1400–1404. https://doi.org/10.2106/JBJS.15.00914
Arvinte D, Kiran M, Sood M (2015) Femoral head-trunnion dissociation secondary to corrosion of a modular total hip replacement: a case report. JBJS Case Connect 5(2):e4–e35. https://doi.org/10.2106/jbjs.cc.n.00146
Mariconda M, Galasso O, Costa GG, Recano P, Cerbasi S (2011) Quality of life and functionality after total hip arthroplasty: a long-term follow-up study. BMC Musculoskelet Disord 12:222. https://doi.org/10.1186/1471-2474-12-222
Svensson O, Mathiesen EB, Reinholt FP, Blomgren G (1988) Formation of a fulminant soft-tissue pseudotumor after uncemented hip arthroplasty. A case report. J Bone Joint Surg Am 70(8):1238–1242
Goldberg JR, Gilbert JL (2003) In vitro corrosion testing of modular hip tapers. J Biomed Mater Res B Appl Biomater 64(2):78–93. https://doi.org/10.1002/jbm.b.10526
Walker P, Campbell D, Della Torre P, Brazil D, McTighe T (2016) Trunnion Corrosion and early failure in monolithic metal-on-polyethylene TMZF femoral components: a case series. Reconstr Rev 6(3):13–18. https://doi.org/10.15438/rr.6.3.161
Fokter SK, Molicnik A, Kavalar R, Pelicon P, Rudolf R, Gubeljak N (2017) Why do some titanium-alloy total hip arthroplasty modular necks fail? J Mech Behav Biomed Mater 69:107–114. https://doi.org/10.1016/j.jmbbm.2016.12.012
Fokter SK, Repse-Fokter A, Takac I (2009) Case report: femoral neuropathy secondary to total hip arthroplasty wear debris. Clin Orthop Relat Res 467(11):3032–3035. https://doi.org/10.1007/s11999-009-0894-7
Acknowledgements
We acknowledge Dr. Ian Martin, DO, for his assistance in the presentation and description of our pathology results and provided photomicrograph. We acknowledge Dr. Wesley Stroud, MD, for the illustrative intraoperative images and medical record review.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors whose names are listed immediately below certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.
Statement of informed consent
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.
Rights and permissions
About this article
Cite this article
Hunter, A.M., Hsu, A., Shah, A. et al. A case example and literature review of catastrophic wear before catastrophic failure: identification of trunnionosis and metallosis in metal-on-polyethylene hip arthroplasty prior to frank failure or fracture. Eur J Orthop Surg Traumatol 29, 711–715 (2019). https://doi.org/10.1007/s00590-018-2333-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-018-2333-5