Impaction Force Influences Taper-Trunnion Stability in Total Hip Arthroplasty

Background: This study investigated the influence of femoral head impaction force, number of head strikes, the energy sequence of head strikes, and head offset on the strength of the taper-trunnion junction. Methods: Thirty titanium-alloy trunnions were mated with 36-mm zero-offset cobalt-chromium femoral heads of corresponding taper angle. A drop tower impacted the head with 2.5J or 8.25J, resulting in 6 kN or 14 kN impaction force, respectively, in a single strike or combinations of 6 kN thorn 14 kN or 14 kN thorn 14 kN. In addition, ten 36-mm heads with -5 and +5 offset were impacted with sequential 14 kN thorn 14 kN strikes. Heads were subsequently disassembled using a screw-driven mechanical testing frame, and peak distraction force was recorded. Results: Femoral head pull-off force was 45% the strike force, and heads struck with a single 14 kN impact showed a pull-off force twice that of the 6 kN group. Two head strikes with the same force did not improve pull-off force for either 6 kN (P = .90) or 14 kN (P = .90). If the forces of the 2 impactions varied, but either impact measured 14 kN, a 51% higher pull-off force was found compared to impactions of either 6 kN or 6 kN thorn 6 kN. Femoral head offset did not significantly change the pull-off force among -5, 0, and +5 heads (P = .37). Conclusion: Femoral head impaction force influenced femoral head trunnion-taper stability, whereas offset did not affect pull-off force. Multiple head strikes did not add additional stability, as long as a single strike achieved 14 kN force at the mallet-head impactor interface. Insufficient impaction force may lead to inadequate engagement of the trunnion-taper junction. (c) 2018 Elsevier Inc. All rights reserved.