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



Mirghaderi SP1 ; Hoveidaei AH1 ; Sheikhbahaei E2 ; Motififard M3 ; Moradi N4 ; Moradi M5
Authors
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Authors Affiliations
  1. 1. Joint Reconstruction Research Center (JRRC), Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  3. 3. Department of Orthopedic Surgery, Kashani University Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
  4. 4. School of Pharmacy, Kermanshah University of Medical Sciences, Kermanshah, Iran
  5. 5. Department of Orthopedic Surgery, School of Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Source: Archives of Bone and Joint Surgery Published:2022


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. COPYRIGHT 2022 © BY THE ARCHIVES OF BONE AND JOINT SURGERY.
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