This report presents two cases of gross trunnion failure (GTF) following total hip arthroplasty (THA) that demonstrate dissociation of the femoral head from the trunnion, as well as elevated serum ion levels and metal-on-polyethylene eccentric wear. Risk factors for GTF including body mass index (BMI) >30 kg/m2, male sex, low angled neck, high offset femoral stems, and large alloy metal heads were present in both patients. Patients that have risk factors or specific components prone to GTF should be monitored closely for symptoms, elevated serum ion levels, and radiographic signs of GTF to avoid catastrophic failure necessitating revision arthroplasty.

Keywords: Elderly; Male and female; Gross trunnion failure; Trunnionosis; Stryker accolade I femoral stem; Metallosis; Adverse local tissue reaction; Obesity; Inability to ambulate; Pain; Elevated cobalt and chromium serum ion levels; Dissociation of modular femoral head; Revision total hip arthroplasty; Accolade TMZF