Search

Trunnionosis is emerging as an early mode of failure in conventional metal-on-polyethylene total hip arthroplasty. It is defined as wear or corrosion at the trunnion, the taper at the femoral head-neck interface. Trunnion wear can result in a variety of negative sequelae and, in severe cases, necessitate revision arthroplasty. We describe a 64-year-old man with a metal-on-polyethylene total hip arthroplasty who presented with a sensation of clunking in the hip. Initial imaging and laboratory studies were inconclusive, and the decision was made to monitor. Two years later, trunnion wear was detected on radiographs, presenting as an abnormal alignment of the femoral neck relative to the femoral head. Several case reports and series describe catastrophic total hip arthroplasty failure due to trunnionosis. However, few describe the radiographic signs of wear at the trunnion before gross failure. This early presentation is important to recognize to minimize patient morbidity and aid surgical planning.

We describe a case of a 69-year-old male with a right-sided popliteal mass following a motor vehicle accident 15 years ago. The mass was indeterminate via multiple modalities (magnetic resonance imaging, digital subtraction angiography, and vascular ultrasound) with biopsy requested prior to surgical removal to determine the appropriate surgical team – vascular versus sarcoma oncologic surgery. Contrast ultrasound was utilized to determine if biopsy was indicated and if so, to determine the most appropriate target. Contrast ultrasound showed no areas of enhancement, therefore biopsy was not performed and the patient safely proceeded to vascular surgery. Pathology confirmed the mass to be a thrombosed pseudoaneurysm of the popliteal artery. We present the benefits of using contrast ultrasound in the work up and diagnosis of a popliteal neoplasm versus suspected vascular complication.