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


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


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


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 followup,
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:
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:
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:
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:
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:
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.
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.
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/
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.
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 largediameter
metal-on-metal bearing articulations.
J Bone Joint Surg Br. 2010;92-B(1):12-9. doi:
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/
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:
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/
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:
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:
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:
28. Davies AP, Willert HG, Campbell PA, Learmonth
ID, Case CP. An unusual lymphocytic perivascular
infiltration in tissues around contemporary metalon-
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:
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.
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:
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.
Volume 10, Issue 10
October 2022
Pages 911-915
  • Receive Date: 27 October 2021
  • Revise Date: 05 July 2022
  • Accept Date: 19 July 2022
  • First Publish Date: 15 September 2022