Review Question - QID 219937

The patient has sustained catastrophic failure of their femoral component due to trunnion wear. The best option is to revise the femoral component with conversion to a ceramic head and a new polyethylene insert (answer choice 2).

Head-neck corrosion or trunnionosis can lead to catastrophic failure of modular total hip arthroplasty components. Risk factors for trunnionosis include larger femoral heads, thinner or shorter trunnions, and cobalt chrome heads on titanium tapers. The mainstay of treatment for trunnionosis is revision arthroplasty. In most patients, revision surgery involves a modular femoral head exchange to a ceramic head with a titanium sleeve and a liner exchange. The titanium sleeve helps prevent ceramic head fracture due to existing taper damage. Revising a well-fixed stem is often unnecessary unless the taper is grossly damaged. In this case, there is failure of the femoral component, so it should be removed and revised. Treatment should also consist of liner exchange and placement of a ceramic head.

Kwon et al. provide an algorithm for treating patients with trunnionosis based on AAHKS, AAOS, and the Hip Society recommendations. The authors conclude that the femoral component should be revised in cases of severe damage to the taper. They recommend the use of a ceramic head with a titanium liner.

Swan et al. report two cases of femoral component catastrophic failure due to trunnionosis. The authors recommend a treatment consisting of femoral component revision, conversion to ceramic head, and new polyethylene liner placement.

Figure A demonstrates catastrophic failure of the femoral component with head-neck dissociation and significant trunnion wear.

Incorrect Answers:
Answer 1: This patient has sustained failure of his femoral component. Observation would not be appropriate at this point.
Answer 3: Given that the stem is likely grossly damaged in this situation, a full femoral component revision is necessary.
Answer 4: The acetabular component is well-fixed and does not require revision.
Answer 5: Given that this patient has already sustained failure of his femoral component, proceeding to operative treatment would be the next best step.