The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Femoral Stem Dislocation Caused by Trunnionosis Along with Adverse Local Tissue Reaction: A Case Report and a New Technique of Head to Cone Cementing

Document Type : CASE REPORT

Authors
Seyed Peyman Mirghaderi 1
Amir Human Hoveidaei 1
Erfan Sheikhbahaei 2
Mehdi Motififard 3
Nader Moradi 4
Mansour Moradi 5
1 Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
2 Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
5 Department of Orthopedic Surgery, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences Isfahan, Iran
10.22038/abjs.2022.61214.3005
Abstract
In total hip replacement (THR), fretting and corrosion at the modular head-neck junction (trunnionosis) may cause
adverse local tissue reaction (ALTR). In this report, we presented a 34 years woman with a history of THR eight years
ago, presenting with acute pain and limping. The radiographic assessment revealed stem-head dislocation for which
a revision hip surgery was planned. Surprisingly, we observed pseudotumor and tissue necrosis resulting from the
body’s reaction to cobalt-chromium alloy. The revision surgery entailed pseudotumor debridement and replacing the
femoral head with a new metal head (size 36, long). Due to the separation of the femoral head on a stem, we fixed
it on a stem using bone cement. The stem (Omnifit®, Stryker®) was well-fixed and retained to avoid fractures and
infection risk. This technique revealed an acceptable outcome without recurrence of ALTR after a one-year follow-up.
Our findings suggest that stem dislocation secondary to trunnionosis might be a long-term complication after THR
with subsequent ALTR.
Level of evidence: V
Keywords
Arthroplasty
Hip dislocation
Hip prosthesis
Long term adverse effects
Po stoperative complications
  1. Kim YH, Kim JS, Park JW, Joo JH. Contemporary total hip arthroplasty with and without cement in patients with osteonecrosis of the femoral head: a concise follow-up, at an average of seventeen years, of a previous report. J Bone Joint Surg Am. 2011;93(19):1806-10. doi: 10.2106/JBJS.J.01312.
  2. Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA. Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am. 2007;89(3):526-33. doi: 10.2106/JBJS.F.00952.
  3. Mirghaderi SP, Sharifpour S, Moharrami A, et al. Determining the accuracy of preoperative total hip replacement 2D templating using the mediCAD® software. J Orthop Surg Res. 2022;17(1):222. doi: 10.1186/s13018-022-03086-5.
  4. Sheikhbahaei E, Mirghaderi SP, Moharrami A, Habibi D, Motififard M, Mortazavi SMJ. Incidence of Symptomatic COVID-19 in Unvaccinated Patients Within One Month After Elective Total Joint Arthroplasty: A Multicenter Study. Arthroplasty Today. 2022;14:110-5. doi: 10.1016/j.artd.2022.01.024.
  5. Jamshidi MM, Moharrami A, Sharifpour S, Mafi AR, Mortazavi SJ. The Role of Spinopelvic Parameters in Total Hip Arthroplasty: A Current Concept Review. Journal of Orthopedic and Spine Trauma. 2022;8(2):40-3. https://doi.org/10.18502/jost.v8i2.9308.
  6. Goldberg JR, Gilbert JL, Jacobs JJ, Bauer TW, Paprosky W, Leurgans S. A multicenter retrieval study of the taper interfaces of modular hip prostheses. Clin Orthop Relat Res. 2002(401):149-61. doi: 10.1097/00003086-200208000-00018.
  7. Cooper HJ, Urban RM, Wixson RL, Meneghini RM, Jacobs JJ. 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. 2013;95(10):865-72. doi: 10.2106/JBJS.L.01042.
  8. Fallah E, Moharrami A, Nouri AH, Jamshidi MM, Mafi AR, Mortazavi SJ. The Role of Tranexamic Acid in Reducing Blood Loss Following Total Joint Arthroplasty: A Review Article. Journal of Orthopedic and Spine Trauma. 2022;8(1):5-8 https://doi.org/10.18502/jost.v8i1.9038.
  9. Jamshidi MM, Moharrami A, Ghasemi MA, Mafi AR, Mortazavi SJ. Intrapelvic Migration of Dynamic Hip Screw Postoperatively Leading to Total Hip Arthroplasty: A Case Report. Journal of Orthopedic and Spine Trauma. 2022;8(2):69-71. https://doi.org/10.18502/jost.v8i2.9316
  10. Moharrami A, Mafi AH, Fallah E, Salehi M, Mortazavi SMJ. Total joint arthroplasty in the patients with haemophilia: General or neuraxial anaesthesia? Haemophilia. 2022;28(4):e95-e97. doi: 10.1111/hae.14509.
  11. Moharrami A, Mortazavi SJ. Total joint arthroplasty in hemophilic patients: Spinal anesthesia is an option? Haemophilia. Volume25, IssueS3.Special Issue: WFH 16th International Musculoskeletal Congress, Madrid, Spain, 2019. https://doi.org/10.1111/hae.13856
  12. Pastides PS, Dodd M, Sarraf KM, Willis-Owen CA. Trunnionosis: A pain in the neck. World J Orthop. 2013;4(4):161-6. doi: 10.5312/wjo.v4.i4.161.
  13. Mistry JB, Chughtai M, Elmallah RK, et al. Trunnionosis in total hip arthroplasty: a review. J Orthop Traumatol. 2016;17(1):1-6. doi: 10.1007/s10195-016-0391-1.
  14. Mistry JB, Chughtai M, Elmallah RK, et al. Trunnionosis in total hip arthroplasty: a review. J Orthop Traumatol. 2016;17(1):1-6. doi: 10.1007/s10195-016-0391-1.
  15. Kwon Y-M. Adverse Local Tissue Reactions in Total Hip Arthroplasty: Who, When, and How to Revise. J Arthroplasty. 2020;35(6):S53-S4. doi: 10.1016/j.arth.2019.12.042.
  16. Liow MHL, Kwon Y-M. Metal-on-metal total hip arthroplasty: risk factors for pseudotumours and clinical systematic evaluation. Int Orthop. 2017;41(5):885-92. doi: 10.1007/s00264-016-3305-1.
  17. Vendittoli PA, Roy A, Mottard S, Girard J, Lusignan D, Lavigne M. Metal ion release from bearing wear and corrosion with 28 mm and large-diameter metal-on-metal bearing articulations. J Bone Joint Surg Br. 2010;92-B(1):12-9. doi: 10.1302/0301-620X.92B1.22226.
  18. Cooper HJ, Della Valle CJ, Berger RA, et al. Corrosion at the head-neck taper as a cause for adverse local tissue reactions after total hip arthroplasty. J Bone Joint Surg Am. 2012;94(18):1655-61. doi: 10.2106/jbjs.k.01352.
  19. Walker P, Campbell D, Della Torre P, Brazil D, McTighe T. Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series. Reconstructive Review. 2016;6(3).
  20. Lindgren JU, Brismar BH, Wikstrom AC. Adverse reaction to metal release from a modular metal-on-polyethylene hip prosthesis. J Bone Joint Surg Br. 2011;93(10):1427-30. doi: 10.1302/0301-620X.93B10.27645.
  21. Stahnke JT, Sharpe KP. Pseudotumor Formation in a Metal-on-polyethylene Total Hip Arthroplasty Due to Trunnionosis at the Head-neck Taper. Surg Technol Int. 2015;27:245-50.
  22. Patel S, Talmo CT, Nandi S. Head-neck taper corrosion following total hip arthroplasty with Stryker Meridian stem. Hip Int. 2016;26(6):e49-e51. doi: 10.5301/hipint.5000440.
  23. Plummer DR, Berger RA, Paprosky WG, Sporer SM, Jacobs JJ, Della Valle CJ. Diagnosis and Management of Adverse Local Tissue Reactions Secondary to Corrosion at the Head-Neck Junction in Patients With Metal on Polyethylene Bearings. J Arthroplasty. 2016;31(1):264-8. doi: 10.1016/j.arth.2015.07.039.
  24. Kiernan S, Kaptein B, Flivik C, Sundberg M, Flivik G. Unexpected varus deformity and concomitant metal ion release and MRI findings of modular-neck hip stems: descriptive RSA study in 75 hips with 8 years’ follow-up. Acta Orthop. 2021;92(1):67-73. doi: 10.1080/17453674.2020.1853387.
  25. Herndon CL, Shah RP, Cooper HJ, Geller JA. A case of bilateral hip mechanically assisted crevice corrosion after staged total hip arthroplasty. Arthroplast Today. 2018;4(3):261-5. doi: 10.1016/j.artd.2018.05.003.
  26. Mirghaderi SP, Raeini AG, Gholamshahi H, Mortazavi SMJ, Shafiei SH, Sheikhvatan M. Content Validity and Reliability of the Persian Version of the Forgotten Joint Score Questionnaire in Patients Undergoing Total Hip Arthroplasty. Arthroplast Today. 2022;15:40-2. doi: 10.1016/j.artd.2022.01.031.
  27. Urban RM, Jacobs JJ, Gilbert JL, Galante JO. Migration of corrosion products from modular hip prostheses. Particle microanalysis and histopathological findings. J Bone Joint Surg Am. 1994;76(9):1345-59. doi: 10.2106/00004623-199409000-00009.
  28. Davies AP, Willert HG, Campbell PA, Learmonth ID, Case CP. An unusual lymphocytic perivascular infiltration in tissues around contemporary metal-on-metal joint replacements. J Bone Joint Surg Am. 2005;87(1):18-27. doi: 10.2106/JBJS.C.00949.
  29. Kwon YM, Xia Z, Glyn-Jones S, Beard D, Gill HS, Murray DW. Dose-dependent cytotoxicity of clinically relevant cobalt nanoparticles and ions on macrophages in vitro. Biomed Mater. 2009;4(2):025018. doi: 10.1088/1748-6041/4/2/025018.
  30. Menendez ME, Ring D, Barnes CL. Inpatient Dislocation After Primary Total Hip Arthroplasty. J Arthroplasty. 2016;31(12):2889-93. doi: 10.1016/j.arth.2016.05.007.
  31. Mortazavi SMJ, Ghadimi E, Ardakani MV, et al. Risk factors of dislocation after total hip arthroplasty in patients with developmental dysplasia of the hip. International Orthopaedics. 2022;46(4):749-59. doi: 10.1007/s00264-021-05294-w.
  32. Freccero DM, McAlpine KJ, Smith EL. Taper fretting corrosion with Stryker Anato stem after hip replacement. Arthroplast Today. 2020;6(2):210-3. doi: 10.1016/j.artd.2020.01.011.
The Archives of Bone and Joint Surgery
Volume 10, Issue 10
October 2022
Pages 911-915

  • Receive Date 27 October 2021
  • Revise Date 05 July 2022
  • Accept Date 19 July 2022