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Modern Trunnions Are More Flexible: A Mechanical Analysis of THA Taper Designs

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

Abstract

Background

There is renewed concern surrounding the potential for corrosion at the modular head-neck junction to cause early failure in contemporary THAs. Although taper corrosion involves a complex interplay of many factors, a previous study suggested that a decrease in flexural rigidity of the femoral trunnion may be associated with an increased likelihood of corrosion at retrieval.

Questions/purposes

By analyzing a large revision retrieval database of femoral stems released during a span of three decades, we asked: (1) how much does flexural rigidity vary among different taper designs; (2) what is the contribution of taper geometry alone to flexural rigidity of the femoral trunnion; and (3) how have flexural rigidity and taper length changed with time in this group of revised retrievals?

Methods

A dual-center retrieval analysis of 85 modular femoral stems released between 1983 and 2012 was performed, and the flexural rigidity and length of the femoral trunnions were determined. These stems were implanted between 1991 and 2012 and retrieved at revision or removal surgery between 2004 and 2012. There were 10 different taper designs made from five different metal alloys from 16 manufacturers. Digital calipers were used to measure taper geometries by two independent observers.

Results

Median flexural rigidity was 228 N-m2; however, there was a wide range of values among the various stems spanning nearly an order of magnitude between the most flexible (80 N-m2) and most rigid (623 N-m2) trunnions, which was partly attributable to the taper geometry and to the material properties of the base alloy. There was a negative correlation between flexural rigidity and length of the trunnion and release date of the stem.

Conclusions

There is wide variability in flexural rigidity of various taper designs, with a trend toward trunnions becoming shorter and less rigid with time.

Clinical Relevance

This temporal trend may partly explain why taper corrosion is being seen with increasing frequency in modern THAs.

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Acknowledgments

We thank Jennifer L. Wright MS (Department of Orthopaedic Surgery, Rush University Medical Center) for contributions in performing trunnion measurements.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Lenox Hill Hospital, 130 East 77th Street, 11th Floor, New York, NY, 10024, USA

    David A. Porter MD, José A. Rodriguez MD & H. John Cooper MD

  2. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Robert M. Urban PhD & Joshua J. Jacobs MD

  3. Department of Biomedical and Chemical Engineering, Syracuse University, Syracuse, NY, USA

    Jeremy L. Gilbert PhD

Authors
  1. David A. Porter MD
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  2. Robert M. Urban PhD
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  3. Joshua J. Jacobs MD
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  4. Jeremy L. Gilbert PhD
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  5. José A. Rodriguez MD
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  6. H. John Cooper MD
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Corresponding author

Correspondence to H. John Cooper MD.

Additional information

One or more of the authors certifies that he, or a member of his immediate family, has or may receive payments or benefits, during the study period, amounts of USD 10,000 to 100,000 (RMU, JAR) from Wright Medical Technology (Arlington, TN, USA); an amount less than USD 10,000 (HJC), and an amount of USD 10,000 to 100,000 (JAR) from Smith & Nephew Orthopaedics (Memphis, TN, USA); an amount less than USD 10,000 (RMU), an amount of USD 10,000 to 100,000 (JAR), and an amount of USD 100,000 to 1,000,000 (JLG) from DePuy, a Johnson & Johnson Company (Warsaw, IN, USA); amounts of USD 10,000 to 100,000 (RMU, JJJ, HJC) from Zimmer (Warsaw, IN, USA); an amount of USD 10,000 to 100,000 (JLG) from Stryker Orthopaedics (Mahway, NJ, USA); an amount less than USD 10,000 (RMU) from Spinal Motion (San Antonio, TX, USA); amounts less than USD 10,000 to 100,000 (JJJ, JLG) from Medtronic Sofamor Danek (Memphis, TN, USA); an amount of USD 10,000 to 100,000 (JAR) from Medacta (Castel San Pietro, Switzerland); an amount of USD 10,000 to 100,000 (JAR) from Exactech Inc (Great Neck, NY, USA); an amount less than USD 10,000 (JJJ) from Implant Protection (Raanana, Israel); and an amount of USD 10,000 to 100,000 (JJJ) from NuVasive (San Diego, CA, USA).

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.

Clinical Orthopaedics and Related Research ® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA-approval status, of any drug or device prior to clinical use.

Each author certifies that all investigations were conducted in conformity with ethical principles of research.

This work was performed at Lenox Hill Hospital, New York, NY, USA, and Rush University Medical Center, Chicago, IL, USA.

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Porter, D.A., Urban, R.M., Jacobs, J.J. et al. Modern Trunnions Are More Flexible: A Mechanical Analysis of THA Taper Designs. Clin Orthop Relat Res 472, 3963–3970 (2014). https://doi.org/10.1007/s11999-014-3965-3

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  • DOI: https://doi.org/10.1007/s11999-014-3965-3

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