Abstract
Taper corrosion and Trunionnosis are recognized as a major complication of hip replacement surgery presenting in a variety of clinical manifestations commonly referred to as Adverse Local Tissue Reactions. Metal debris is produced through Mechanically Assisted Crevice Corrosion with several implicating factors including mixed alloy components, taper design, head offset, femoral head size, and taper impaction techniques (including magnitude of force, control of alignment and environmental factors). Our project has focused singularly on taper impaction techniques and surgeon controlled factors, as we believe the process of head impaction unto a trunnion is non-standardized, which often times dooms the trunionn to failure. We have contemplated a standardization process, such that given the right tool, the surgeon can control the quality of the taper interlock, which may produce a “cold weld” or perfect taper interlock, eliminate micro motion, mechanically assisted crevice corrosion, and trunionnosis. We have considered four specific problems with current head to trunionn impaction techniques: 1. The magnitude of applied force is uncontrolled, haphazard, and non-standardized. 2. Non-axial application of force is the norm, which produces canting, leading to micro-motion and tribocorrosion. 3. The transfer of energy from the head to the trunionn interface is highly inefficient, such that the energy produced by the surgeon is mostly dissipated in a non-constrained system. 4. No in vitro studies exist to guide surgeons as to the magnitude of force required for a proper interlock.
Regardless of the design, including taper angles, larger heads, offset heads, mixed alloy components, shorter and slimmer trunionns there is a widespread problem with the process of head impaction onto the trunionn and the engagement of the modular taper interface that dooms the trunionn interface to failure. The deficiencies noted in current techniques are addressed with a simple tool and minor modification of the femoral stem. We present a new concept/apparatus for head to trunionn taper assembly that fully controls the magnitude and direction of assembly force within a constrained, dry and contaminant free environment. This tool allows application of a perfectly axial and high insertional forces without risk of damage to the femoral stem/bone interface to obtain a cold weld and perfect taper interlock with no chance for canting, micro motion and tribocorrosion. The concept has been verified through several prototypes and can be adopted in order to standardize the process of taper assembly, making this procedure independent of surgeon skill and strength, and minimizing the incidence of trunionnosis.
