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World J Orthop. Oct 18, 2013; 4(4): 161-166
Published online Oct 18, 2013. doi: 10.5312/wjo.v4.i4.161
Trunnionosis: A pain in the neck
Philip S Pastides, Matthew Dodd, Khaled M Sarraf, Charles A Willis-Owen
Philip S Pastides, Department of Trauma and Orthopedics, Charing Cross Hospital, Imperial NHS Trust, London W6 8RF, United Kingdom
Matthew Dodd, Department of Trauma and Orthopedics, Morriston Hospital, Swansea University, Swansea SA6 6NL, Wales, United Kingdom
Khaled M Sarraf, Department of Trauma and Orthopedics, Barnet General Hospital, Barnet EN5 3DJ, United Kingdom
Charles A Willis-Owen, Department of Trauma and Orthopedics, Queen Elizabeth Hospital Woolwich, London SE18 4QH, United Kingdom
Author contributions: Pastides PS, Dodd M wrote the article; Sarraf KM reviewed and edited the manuscript; Willis-Owen CA had the original idea and edited the manuscript.
Correspondence to: Dr. Philip S Pastides, Department of Trauma and Orthopedics, Charing Cross Hospital, Imperial NHS Trust, Fulham Palace Road, London W6 8RF, United Kingdom. ppastides@hotmail.com
Telephone: +44-77-86512410 Fax: +44-20-8815558
Received: June 19, 2013
Revised: July 17, 2013
Accepted: July 23, 2013
Published online: October 18, 2013

Metal-on-metal (MoM) hip replacements have proven to be a modern day orthopaedic failure. The early enthusiasm and promise of a hard, durable bearing was quickly quashed following the unanticipated wear rates. The release of metal ions into the blood stream has been shown to lead to surrounding soft tissue complications and early failure. The devastating destruction caused has led to a large number of revision procedures and implant extractions. The resulting research into this field has led to a new area of interest; that of the wear at the trunnion of the prosthesis. It had been previously thought that the metal debris was generated solely from the weight bearing articulation, however with the evolution of modularity to aid surgical options, wear at the trunnion is becoming more apparent. The phenomenon of “trunnionosis” is a rapidly developing area of interest that may contribute to the overall effect of metallosis in MoM replacements but may also lead to the release of metal ions in non MoM hip designs. The aim of this paper is to introduce, explain and summarise the evidence so far in the field of trunnionosis. The evidence for this phenomenon, the type of debris particles generated and a contrast between MoM, non MoM and resurfacing procedures are also presented.

Keywords: Wear, Trunnion, Ions, Arthroplasty, Hip

Core tip: Metal ions, derived from Metal-on-Metal (MoM) hip replacements have been a subject of interest since the catastrophic failure of this bearing surface. However, debris generation is not solely limited to the articulating surface, but can arise from the interface between the head and neck at the trunnion. Furthermore, it appears that the phenomenon of ‘trunnionosis’ is not limited to only MoM prosthesis, but to all modular designs and may therefore contribute to the problem of metallosis.