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

Trunnionosis has emerged as an increasingly recognized cause of failure in total hip arthroplasty (THA). Although multiple prosthesis-related factors have been proposed, the relative importance of these risk factors remains uncertain. A comprehensive literature review and case-based analysis were conducted using the PubMed database (up to June 15, 2025) to identify and validate prosthesis-related risk factors for trunnionosis. Device-specific data extracted from eligible case reports were aggregated to empirically confirm previously hypothesized mechanical and material risk factors. The most consistent prosthesis-related risk factors were cobalt-chromium femoral heads, stems composed of titanium-molybdenum-zirconium-iron (TMZF) alloy, large-diameter femoral heads (≥ 36 mm), increased head-neck offset, and short trunnion length. Adverse taper geometries-such as smaller diameters, shorter lengths, and specific taper angles-were associated with greater micromotion and fretting corrosion. Grooved or threaded trunnion surfaces and dual modular stem designs further amplified the risk. High body mass index, male sex, elevated activity levels, and prolonged implantation duration were recurrent patient-related contributors, whereas surgical factors such as inadequate impaction force, malalignment, and contamination during assembly also promoted early taper corrosion. Contemporary THA designs that favor large femoral heads and high-offset stems increase mechanical loading at the taper junction, inadvertently predisposing to trunnionosis. Preventive strategies should prioritize the use of ceramic heads, avoidance of TMZF stems, and careful consideration of trunnion geometry. Standardization of taper design, adherence to meticulous assembly techniques, and long-term postoperative surveillance are essential to minimize corrosion-related failures and improve implant longevity.