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Case Reports
. 2023 Nov 25;15(11):e49401.
doi: 10.7759/cureus.49401. eCollection 2023 Nov.

Trunnionosis in Metal-on-Polyethylene Total Hip Arthroplasty With Periprosthetic Infection: A Case Report

Fumito Kobayashi  1 , Kenichi Oe  1 , Shohei Sogawa  1 , Tomohisa Nakamura  1 , Takanori Saito  1
Affiliations
Case Reports

Trunnionosis in Metal-on-Polyethylene Total Hip Arthroplasty With Periprosthetic Infection: A Case Report

Fumito Kobayashi et al. Cureus. .

Abstract

A 67-year-old man who underwent right hemiarthroplasty and left total hip arthroplasty (THA) experienced left hip pain two years previously. No previous diagnosis was made at other hospitals. Radiography revealed left hip trunnionosis because of stem-neck shortening, with periprosthetic joint infection (PJI) spreading to both hips. Bilateral revision THA was performed, but the treatment was difficult due to the delayed diagnosis, necessitating the extraction of the well-fixed stem for PJI. Trunnionosis is caused by implant-related, surgical, and patient factors, and early diagnosis is important because of its association with PJI. Furthermore, even implants with few reports of trunnionosis can lead to this complication. Surgeons should always consider that performing THA using a large-diameter head predisposes the patient to trunnionosis.

Keywords: adverse reaction to metal debris; metal-on-polyethylene; periprosthetic joint infection; total hip arthroplasty (tha); trunnionosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Anteroposterior radiograph.
(a) At seven years after left total hip arthroplasty (THA) and three months after right hemiarthroplasty. (b) At 11 years after THA and four years after hemiarthroplasty. (c) At 13 years after THA and six years after hemiarthroplasty.
Figure 2
Figure 2. Preoperative imaging.
(a) T2-weighted magnetic resonance imaging showed a pseudotumor in the left hip. (b) Bone scintigraphy showed uptake in both hips.
Figure 3
Figure 3. Intraoperative photographs.
(a) Stem appearance showed the deformity of the trunnion. (b) Metal debris was observed between the cup and the acetabulum.
Figure 4
Figure 4. Anteroposterior radiograph.
(a) Right-hip one-stage revision total hip arthroplasty (THA) was performed, and antibiotic-loaded acrylic cement beads and rod were deposited in the left hip after bilateral debridement. (b) Left-hip two-stage revision THA was performed 6.5 weeks later.
Figure 5
Figure 5. Progression of C-reactive protein level and treatment course.
CRP: C-reactive protein, DPT: daptomycin, LVFX: levofloxacin, MEPM: meropenem trihydrate.
See this image and copyright information in PMC

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