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Orthopedic surgeon discusses current management strategies for trunion corrosion
In a review article in The Journal of Arthroplasty, Michael P. Bolognesi, MD, discussed current recommendations for management of trunion corrosion in hip implants, noting that surgeons should be prepared for all possibilities during revision.
“The operations could go from simple to complex based on what you find at the time of surgery and that may not be completely evidence from the preoperative work-up,” Bolognesi told Healio.com/Orthopedics.
In his article, Bolognesi noted the head implant of choice for most of the cases with trunion corrosion is believed to be ceramic heads with titanium sleeves. However, currently there are no clearly accepted methods for cleaning or polishing a damaged taper and data are inadequate regarding how much soft tissue debridement is required.
“The approach to these cases in some ways should follow the standard approach for all revision hip cases,” Bolognesi wrote. “All patients should have the appropriate preoperative serum markers analyzed. Based on these markers, the surgeon may choose to perform frozen section analysis intraoperatively.”
To remove all nonviable and suspicious tissues, Bolognesi wrote surgeons perform a complete synovectomy in most cases, which can be challenging “depending on the extent of involvement and the relative proximity of abnormal tissues to vital structures.” He added that although some debridement must be performed, there is no outline on how extensive the debridement must be.
“It is important for the surgeons to be mindful of the extent of debridement that occurs as it pertains to structures like the abductor complex and that might affect implant construction selection related to increasing constraint,” Bolognesi wrote.
When it comes to decision making about stem retention, surgeons should know the extent of involvement and damage, according to Bolognesi, and may elect to clean the trunion and retain the stem when there is no evidence of severe trunnion failure or deformation.
Despite the current information available on taper corrosion after THA, Bolognesi noted more information is needed following revision.
“I think it is important that this is an area we have to focus on from a research standpoint to make sure that, indeed, we are doing the right things to manage these people,” Bolognesi said. “We have more to learn and we need to study these folks to make sure that the interventions we are making are appropriate.” – by Casey Tingle
Disclosure: Bolognesi reports that he receives royalties for a femoral implant from Zimmer Biomet.
Perspective
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Management of the implant with taper corrosion presents the revision hip surgeon with a host of treatment decisions. Bolognesi nicely summarizes the current state-of-the-art in this recently published article. The primary goal of revision in this setting is to eliminate the source of ongoing cobalt ion release into the effective joint space. To that end, the current recommendation would be to exchange the modular cobalt-chrome femoral head for a revision ceramic head with a titanium alloy adapter sleeve. Exchange of the modular polyethylene acetabular liner is also recommended at the time of this procedure, given the potential for damage to this side of the bearing couple. The author appropriately points out the need to always be prepared for a more extensive reconstruction in the event of concomitant prosthetic impingement, component malposition, instability related to periarticular soft tissue damage and/or catastrophic failure of the trunnion. This article also highlights the need for further study of these patients in order to better understand longer-term outcomes. Specifically, we will need to examine the performance of revision ceramic heads paired with femoral stems having varying degrees of trunnion damage at the time of revision.
Assistant professor of orthopedic surgery
Rochester, Minnesota