MEDLINE Abstracts: Femoral Component Failure in Total Hip Arthroplasty
Maurer SG, Baitner AC, Di Cesare PE
J Am Acad Orthop Surg. 2000 Nov;8(6):354-363
Abstract: Advances in implant technology and surgical techniques have greatly improved the results of femoral stem revision in total hip arthroplasty. The 10-year results obtained with extensively coated noncemented revision stems parallel those obtained with cemented stems revised by using contemporary techniques. Proximal femoral bone loss is an important consideration when planning and performing revision arthroplasty. Proximal femoral bone defects can be managed with either metal or bone. Insignificant defects can be reconstructed by using primary hip arthroplasty techniques. Proximal femoral replacement prostheses are best restricted to sedentary elderly patients. Cortical strut grafts can be used reliably to reconstruct noncircumferential segmental defects. Calcar allografts are associated with unacceptably high rates of resorption. Proximal femoral allografts with either noncemented or cemented long-stem prostheses have the potential advantage of biologic soft-tissue attachment and restoration of bone stock. Impaction allografting with cement is indicated for cavitary defects and may also restore bone stock.
Schmalzried TP, Zahiri CA, Woolson ST
Orthopedics. 2000 Nov;23(11):1157-1164
Abstract: This study analyzed 15 patients who underwent revision for loosening at the stem-cement interface. The femoral components were from the same manufacturer and had grit-blast roughened surfaces. An apparent radiographic deficiency in the cement mantle was present in at least one zone in 1 3 patients. In 9 of 12 patients with localized osteolysis, the osteolysis developed in a zone with an apparent radiographic cement mantle defect. Loosening occurred due to tension failure of the stem-cement interface followed by axial subsidence and movement into relative retroversion. Motion between the stem and the cement mantle fueled an abrasive wear mechanism between the roughened metal surface and the cement mantle, generating excessive metal and cement particles that gained access to endosteal bone via defects in the cement mantle and resulting in localized osteolysis. Although the roughened surface played a central role in these failures, it is unlikely the layer of polymethylmethacrylate (precoat) played a role in the mechanism of failure. In some cases, debonding occurred as a result of tension failure of the metal-precoat interface. In others, tension failure occurred within the cement mantle, leaving the precoat and some cement from the mantle on the stems. There was no difference in the mechanism of failure of stems with precoat proximally compared to stems with precoat proximally and distally. One stem had no precoat; findings in this patient were indistinguishable from the others. The significance of debonding depends on the surface roughness of the stem. Debonding carries a poorer prognosis with a rougher stem surface because of abrasive wear with the generation of numerous metal and cement particulates, which can lead to rapid osteolysis if there are cement mantle defects. Stems with a higher metal-cement bond strength may require a higher quality cement mantle for long-term success.
Christie MJ, DeBoer DK, Tingstad EM, Capps M, Brinson MF, Trick LW
J Arthroplasty. 2000 Oct;15(7):840-848
Abstract: A series of 163 revision total hip arthroplasties performed using a modular proximally porous-coated device was reviewed. Twenty patients died before achieving minimum follow-up, and 13 hips with Paprosky type IV femora were excluded. One patient was lost to follow-up. Minimum 4-year clinical data on the remaining 129 hips showed an improvement in modified Harris hip scores, from an average of 47.7 to 87.5. Spot welds at the sleeve-bone interface were found in 83 of the 102 hips with minimum radiographic follow-up. The aseptic failure rate was 2.9%; these hips showed progressive subsidence, with 1 resulting in the only repeat revision in the series. Three hips had osteolytic lesions of <5 mm; none threatened implant stability. There were no complications related to modularity.
Schmale GA, Lachiewicz PF, Kelley SS
J Arthroplasty. 2000 Sep;15(6):718-729
Abstract: This is a retrospective analysis of 2 methods of fixation of the femoral component in 86 consecutive revision arthroplasties, for which all clinical and radiographic data were recorded prospectively. There were 56 cemented revisions using precoated femoral components followed for 2 to 8 years (mean, 4 years) and 30 uncemented, proximally porous-coated femoral revisions followed for 2 to 6 years (mean, 4 years). Of the 56 cemented hips, 31 (55%) had a good or excellent clinical result. Rerevision has been performed in 10 hips, and revision of 3 loose femoral components is pending (23%). Radiographic review of 56 femoral components showed that 16 (29%) had probable or definite loosening. Of 30 cementless hips, 24 (80%) had a good or excellent clinical result. There was radiographic bone ingrowth in 22 of 30 hips (73%). Seven hips (23%) had nonprogressive subsidence, and 3 hips (10%) had progressive subsidence or loosening. Rerevision has been performed in only 2 hips (7%). The high rate of loosening (29%) and rerevision (23%) at a mean follow-up of only 4 years suggests that a precoated femoral component may place increased stress at the already damaged bone-cement interface.
Maurer SG, Baitner AC, Di Cesare PE
J Am Acad Orthop Surg. 2000 Nov;8(6):354-363
Abstract: Advances in implant technology and surgical techniques have greatly improved the results of femoral stem revision in total hip arthroplasty. The 10-year results obtained with extensively coated noncemented revision stems parallel those obtained with cemented stems revised by using contemporary techniques. Proximal femoral bone loss is an important consideration when planning and performing revision arthroplasty. Proximal femoral bone defects can be managed with either metal or bone. Insignificant defects can be reconstructed by using primary hip arthroplasty techniques. Proximal femoral replacement prostheses are best restricted to sedentary elderly patients. Cortical strut grafts can be used reliably to reconstruct noncircumferential segmental defects. Calcar allografts are associated with unacceptably high rates of resorption. Proximal femoral allografts with either noncemented or cemented long-stem prostheses have the potential advantage of biologic soft-tissue attachment and restoration of bone stock. Impaction allografting with cement is indicated for cavitary defects and may also restore bone stock.
Schmalzried TP, Zahiri CA, Woolson ST
Orthopedics. 2000 Nov;23(11):1157-1164
Abstract: This study analyzed 15 patients who underwent revision for loosening at the stem-cement interface. The femoral components were from the same manufacturer and had grit-blast roughened surfaces. An apparent radiographic deficiency in the cement mantle was present in at least one zone in 1 3 patients. In 9 of 12 patients with localized osteolysis, the osteolysis developed in a zone with an apparent radiographic cement mantle defect. Loosening occurred due to tension failure of the stem-cement interface followed by axial subsidence and movement into relative retroversion. Motion between the stem and the cement mantle fueled an abrasive wear mechanism between the roughened metal surface and the cement mantle, generating excessive metal and cement particles that gained access to endosteal bone via defects in the cement mantle and resulting in localized osteolysis. Although the roughened surface played a central role in these failures, it is unlikely the layer of polymethylmethacrylate (precoat) played a role in the mechanism of failure. In some cases, debonding occurred as a result of tension failure of the metal-precoat interface. In others, tension failure occurred within the cement mantle, leaving the precoat and some cement from the mantle on the stems. There was no difference in the mechanism of failure of stems with precoat proximally compared to stems with precoat proximally and distally. One stem had no precoat; findings in this patient were indistinguishable from the others. The significance of debonding depends on the surface roughness of the stem. Debonding carries a poorer prognosis with a rougher stem surface because of abrasive wear with the generation of numerous metal and cement particulates, which can lead to rapid osteolysis if there are cement mantle defects. Stems with a higher metal-cement bond strength may require a higher quality cement mantle for long-term success.
Christie MJ, DeBoer DK, Tingstad EM, Capps M, Brinson MF, Trick LW
J Arthroplasty. 2000 Oct;15(7):840-848
Abstract: A series of 163 revision total hip arthroplasties performed using a modular proximally porous-coated device was reviewed. Twenty patients died before achieving minimum follow-up, and 13 hips with Paprosky type IV femora were excluded. One patient was lost to follow-up. Minimum 4-year clinical data on the remaining 129 hips showed an improvement in modified Harris hip scores, from an average of 47.7 to 87.5. Spot welds at the sleeve-bone interface were found in 83 of the 102 hips with minimum radiographic follow-up. The aseptic failure rate was 2.9%; these hips showed progressive subsidence, with 1 resulting in the only repeat revision in the series. Three hips had osteolytic lesions of <5 mm; none threatened implant stability. There were no complications related to modularity.
Schmale GA, Lachiewicz PF, Kelley SS
J Arthroplasty. 2000 Sep;15(6):718-729
Abstract: This is a retrospective analysis of 2 methods of fixation of the femoral component in 86 consecutive revision arthroplasties, for which all clinical and radiographic data were recorded prospectively. There were 56 cemented revisions using precoated femoral components followed for 2 to 8 years (mean, 4 years) and 30 uncemented, proximally porous-coated femoral revisions followed for 2 to 6 years (mean, 4 years). Of the 56 cemented hips, 31 (55%) had a good or excellent clinical result. Rerevision has been performed in 10 hips, and revision of 3 loose femoral components is pending (23%). Radiographic review of 56 femoral components showed that 16 (29%) had probable or definite loosening. Of 30 cementless hips, 24 (80%) had a good or excellent clinical result. There was radiographic bone ingrowth in 22 of 30 hips (73%). Seven hips (23%) had nonprogressive subsidence, and 3 hips (10%) had progressive subsidence or loosening. Rerevision has been performed in only 2 hips (7%). The high rate of loosening (29%) and rerevision (23%) at a mean follow-up of only 4 years suggests that a precoated femoral component may place increased stress at the already damaged bone-cement interface.
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