Trunnionosis: the latest culprit in adverse reactions to metal debris following hip arthroplasty

Abstract

The imaging findings of periprosthetic soft tissue lesions (pseudotumours) have been typically defined in the context of newer second-generation metal-on-metal hip arthroplasty. More recently, similar findings have been described in the setting of non-metal-on-metal prostheses. Although uncommon, wear and corrosion between the metal surfaces at the head-neck ('trunnionosis') and neck-stem interfaces are the potential culprits. With modular junctions containing at least one cobalt chromium component frequently present in hip arthroplasty prostheses, the incidence of this mode of adverse wear may be higher than previously thought (irrespective of the specific bearing couple used). In the present report, we described a case of a severe adverse local tissue reaction secondary to suspected corrosion at the head-neck taper in a metal-on-polyethylene total hip arthroplasty and reviewed the literature. Knowledge of this topical entity should help radiologists facilitate early diagnosis and ensure early management of this potentially serious complication.

Effect of Taper Design on Trunnionosis in Metal on Polyethylene Total Hip Arthroplasty

“…Taper corrosion has been shown to manifest clinically as adverse local tissue reactions as shown in previous literature [2][3][4][5][6][7][8][9][10]. In Cooper's series [25], one patient suffered from moderate abductor necrosis due to pseudotumor formation and subsequent dislocations despite an initial revision surgery, requiring a second revision to change to a constrained liner.…”

“…Taper corrosion in modular total hip arthroplasty has recently been recognized to be an important issue, with multiple reports of adverse local tissue reactions even in patients with metal-on-polyethylene arthroplasty [2][3][4][5][6][7][8][9][10]. Cooper et al [3] reviewed ten revised metal-onpolyethylene THA that had elevated serum cobalt and chromium levels, and found visible corrosion at the head-neck junction associated with tissue necrosis and lymphocytic infiltration.…”

Metal-on-Metal Hip Arthroplasty: A Review of Adverse Reactions and Patient Management

“…A recently proposed theory is that trunnionosis, defined as metal wear at the head-neck junction of a total hip implant, is an important contributor (along with wear at the bearing surfaces) to metal particle release in metal-on-metal total hip arthroplasty [ 14 , 15 ]. Trunnionosis is a recognised issue with implants employing a modular design, which are often used to improve prosthetic flexibility when attempting to restore normal hip biomechanics.…”

Dual-taper modular hip implant: Investigation of 3-dimensional surface scans for component contact, shape, and fit

“…Some studies have shown that corrosion at the modular interface is capable of generating metal ion levels that supersede that generated at the MoM articular interface [11]. Although many patients who have received such implants have experienced adverse local tissue reaction (ALTR) secondary to corrosion debris generated at the neck-stem junction [12], [13], [14], [15], [16], [17], ALTR has also been observed in the absence of metallosis [18]. Fretting and corrosion can result in the generation of soluble debris that can migrate locally or systemically and contribute to periprosthetic osteolysis, ALTR, neck fracture, or implant failure [8], [19], [20].…”