Evaluating Trunnionosis in Modular Anatomic Shoulder Arthroplasties: A Retrieval Study.
Journal of Shoulder and Elbow Surgery
BACKGROUND: Shoulder arthroplasty procedures are widely indicated and the number of shoulder arthroplasty procedures has drastically increased over the years. Rapid expansion of the utilization of Reversed Total Shoulder Arthroplasty (rTSA) has outpaced the more modest growth of Anatomic Total Shoulder Arthroplasty (aTSA) while Shoulder Hemiarthroplasty (HA) has trended down. Recently, shoulder prostheses have transitioned to increasingly modular systems offering more individualized options with the potential for decreased pain and increased range of motion. However, increased primary procedures has resulted in increased revision surgeries, with one potential cause being fretting and corrosion damage within these modular systems.
METHODS: Following IRB approval, 130 retrieved aTSA and 135 HA explants were identified through database query. Humeral stem and head components were included in all 265 explants, while 108 included polyethylene (PE) glenoid liner components. All explanted components were macroscopically evaluated for standard damage modes and taper junctions were microscopically examined for fretting/corrosion using a modified Goldberg-Cusick classification system with 4-quadrants-graded for both the male and female component. Medical records were reviewed for patient demographics and surgical information.
RESULTS: In this series, 158 of explants were from female patients (male = 107) and 162 explants were from the right shoulder. Average age at implantation was 61 years (range: 24-83), average age at explanation was 66 years (range, 32-90), and average duration of implantation (DOI) was 61.4 months (range, 0.5-240). Scratching, edge deformation, and burnishing were the most commonly observed standard damage modes as illustrated in (Figure 1). Of the 265 explants, 146 had a male stem component vs. 118 with a female stem component. Average summed fretting grades on male and female stem components were 8.3 and 5.9, respectively (p < 0.001). Average summed corrosion grades for male and female stem components were 8.2 and 6.2, respectively (p < 0.001). Wider male tapers (>11mm) showed significantly less fretting and corrosion (p < 0.001). Lastly, mismatched metal compositions between the head and stem components showed greater fretting and corrosion damage (p = 0.002).
CONCLUSION: In this series of 265 ATSA and HA explants, there is substantial damage present on the explanted components. All components demonstrated macroscopic damage. In this retrieval study, small-tapered male stems with small, thin female heads and mismatched metal composition between components were risk factors for increased implant wear. As shoulder arthroplasty volume increases, optimizing design is paramount for long-term success. Additional work could determine the clinical significance of these findings.
Online ahead of print
Maxwell M, Tooley T, Penvose I, Gehrke C, Koueiter D, Wiater B, et al. [Wiater JM.] Evaluating trunnionosis in modular anatomic shoulder arthroplasties: a Retrieval study. J Shoulder Elbow Surg. 2023 May 18:S1058-2746(23)00378-6. doi: 10.1016/j.jse.2023.04.001. Epub ahead of print. PMID: 37209903.