Prosthesis-Related Risk Factors for Trunnionosis: A Comprehensive Literature Review

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Failure Analysis

Background:

• Trunnionosis is a growing concern in total hip arthroplasty (THA) failures.
• The precise contribution of various prosthesis-related risk factors is not fully understood.

Purpose of the Study:

• To identify and validate prosthesis-related risk factors contributing to trunnionosis.
• To analyze mechanical and material factors influencing taper corrosion in THA.

Main Methods:

• Comprehensive literature review of PubMed up to June 15, 2025.
• Case-based analysis of eligible reports to aggregate device-specific data.
• Empirical validation of hypothesized mechanical and material risk factors.

Main Results:

• Key risk factors identified: cobalt-chromium heads, titanium-molybdenum-zirconium-iron (TMZF) stems, large heads (≥36mm), increased head-neck offset, and short trunnion length.
• Adverse taper geometries (smaller diameter, shorter length, specific angles) correlate with increased micromotion and fretting corrosion.
• Grooved/threaded surfaces, dual modular stems, patient factors (high BMI, male sex, activity), and surgical issues (improper assembly) exacerbate trunnionosis risk.

Conclusions:

• Contemporary THA designs with large heads and high-offset stems increase taper junction loading, predisposing to trunnionosis.
• Preventive strategies include using ceramic heads, avoiding TMZF stems, and optimizing taper geometry.
• Standardized design, meticulous assembly, and long-term surveillance are crucial for minimizing corrosion-related failures and enhancing implant longevity.