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. 2020 Oct 28;2(1):32.
doi: 10.1186/s42836-020-00055-3.

Trunnion fracture of femoral prosthesis following a large metal-on-metal uncemented total hip arthroplasty: a case report

Krishna Kiran Eachempati  1 , Chandra Sekhar Dannana  1 , Sunil Apsingi  1 , Vinay Kishore Ponnala  1 , Giridhar Boyapati  1 , Apurve Parameswaran  2
Affiliations

Trunnion fracture of femoral prosthesis following a large metal-on-metal uncemented total hip arthroplasty: a case report

Krishna Kiran Eachempati et al. Arthroplasty. .

Abstract

Background: Trunnion fracture of the femoral prosthesis is an extremely rare complication following Total Hip Arthroplasty (THA). There are very few reports in literature on trunnion fracture. All previously reported cases are of prostheses with smaller heads, unlike the large metal-on-metal articulation in our case, which is unique.

Case presentation: A 29-year-old male patient with juvenile idiopathic arthropathy presented to us with a fracture of the trunnion of his left THA, with no history of trauma. He had undergone staged bilateral THA for avascular necrosis of the hips 10 years ago (with AML-A stem and large metal-on-metal articulation bilaterally). We revised the THA and exchanged both femoral and acetabular components. He had a good functional outcome at 3 years' follow up.

Conclusion: The primary reason for the trunnion fracture in our case was the faulty stem design of the AML [with a small (9/10) taper, and a large head], causing excessive bending moment at the trunnion, worsening the cantilever effect and leading to subsequent cyclic fatigue failure. Whilst gross trunnion failure (GTF) with dissociation of the head from the taper is commonly reported, trunnion fracture per se is a rare and devastating complication. The AML-A stem has since been recalled by the company and there is a need to constantly monitor these patients for potential trunnion-related complications.

Keywords: Metal on metal; Revision hip arthroplasty; Trunnion fracture; Trunnionosis; Uncemented hip arthroplasty.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
A plain radiograph at the time of presentation, showing bilateral large uncemented metal-on-metal total hip arthroplasty, with trunnion fracture on the left hip
Fig. 2
Fig. 2
a Intra-operative photograph showing the broken trunnion with corrosion at the fracture site and some metallosis. b Close view
Fig. 3
Fig. 3
Radiographs at 6 weeks following surgery, showing trochanteric and femoral wiring for extended trochanteric osteotomy, and the revised stem and cup on the left hip. a Anteroposterior view. b Lateral view
Fig. 4
Fig. 4
Radiographs at 3 years follow up. a Anteroposterior view. b Lateral view
See this image and copyright information in PMC

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