HSS Journal

, 2:114 | Cite as

Early Polyethylene Wear and Excessive Acetabular Granuloma in an Uncemented HA-Coated Total Hip Arthroplasty—Midterm Results of a Prospective Study

  • Jörg Axel Karl Ohnsorge
  • Jack Davis
  • Uwe Maus
  • Muharrem Saklak
  • Markus Weisskopf
  • Dieter Christian Wirtz
Original Article


This is a prospective review of 135 HA-coated ABG I total hip arthroplasty (THA) systems with a mean clinical and radiographic follow-up of 8.5 years. The 5-year survival rate was 85%, but 22% of the patients were dissatisfied. Revision THA was already indicated in 28% of the patients, with 26% indicated for cup loosening. PE wear was detected by x-ray in 42%. Disproportionate substantial wear with an average linear loss of 2.6 mm at the inner rim of the insert was observed in 23% of the cases. The mean annual wear rate was calculated 0.1–0.25 mm/year. Laboratory examination of the retrieved PE revealed polishing, cracks, and subsurface delamination. Radiographic evidence of acetabular cysts were found to be excessive granuloma during surgery. Polarization microscopy revealed debris particles phagocytized by reticuloendothelial cells. Results confirm the general opinion that aseptic osteolysis is a cell-mediated process driven by the presence of particles generated from wear debris. The findings also suggest that the main reasons for the failure of the first-generation ABG hip system were an insufficient locking mechanism and poor PE congruency, and not solely poor PE quality.

Key words

cement-free total hip arthroplasty THA polyethylene wear osteolysis loosening revison ABG I 


  1. 1.
    Geesink RG, de Groot K, Klein CP (1988) Bonding of bone to apatite-coated implants. J Bone Jt Surg Br 70:17–22Google Scholar
  2. 2.
    Tonino A, Oosterboos C, Rahmy A, Thèrin M, Doyle C (2001) Hydroxyapatite-coated acetabular components. J Bone Jt Surg Am 83:817–825Google Scholar
  3. 3.
    Bloebaum RD, Bachus KN, Rubman MH, Dorr LD (1993) Postmortem comparative analysis of titanium and hydroxyapatite porous-coated femoral implants retrieved from the same patient. J Arthroplast 8:203–211CrossRefGoogle Scholar
  4. 4.
    Furlong R, Osborn JF (1991) Fixation of hip prosthesis by hydroxyapatite ceramic coatings. J Bone Jt Surg Br 73(5):741–745Google Scholar
  5. 5.
    Laine HJ, Puolakka TJ, Moilanen T, Pajamaki KJ, Wirta J, Lehto MU (2000) The effects of cementless femoral stem shape and proximal surface texture on ‘fit-and-fill’ characteristics and on bone remodelling. Int Orthop 24(4):184–190CrossRefPubMedGoogle Scholar
  6. 6.
    van Rietbergen B, Huiskes R (2001) Load transfer and stress shielding of the hydroxyapatite-ABG hip: a study of stem length and proximal fixation. J Arthroplast 16(8)1:55–63CrossRefGoogle Scholar
  7. 7.
    d'Antonio JA, Capello WN, Manley MT (1996) Remodeling of bone around hydroxyapatite coated femoral stems. J Bone Jt Surg Am 78:1226Google Scholar
  8. 8.
    Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Jt Surg Am 51:737–755Google Scholar
  9. 9.
    Merle d'Aubigné R, Pastel M (1954) Functional results of hip arthroplasty with acrylic prosthesis. J Bone Jt Surg Am 36:451–475Google Scholar
  10. 10.
    Rossi P, Sibelli P, Fumero S, Crua E (1995) Short-term results of hydroxyapatite-coated primary total hip arthroplasty. Clin Orthop 310:98–102PubMedGoogle Scholar
  11. 11.
    Garcia Araujo C, Fernandez Gonzalez J, Tonino A (1998) Rheumatoid arthritis and hydroxyapatite-coated hip prostheses: five-year results. International ABG Study Group. J Arthroplast 13(6):660–667CrossRefGoogle Scholar
  12. 12.
    Nourissat C (2000) Results with the ABG HA cup after over 10 years. Presented at the International Symposium “Charnley 2000,” Lyon, France, DecemberGoogle Scholar
  13. 13.
    Tonino AJ, Rahmy AI (2000) The hydroxyapatite-ABG hip system: 5- to 7-year results from an international multicentre study. The International ABG Study Group. J Arthroplast 15(3):274–282CrossRefPubMedGoogle Scholar
  14. 14.
    Malchau H, Herberts P, Eisler T, Garellick G, Soderman P (2002) The Swedish Total Hip Replacement Register. J Bone Jt Surg Am 84-A(Suppl 2):2–20Google Scholar
  15. 15.
    Puolakka TJ, Pajamaki KJ, Halonen PJ, Pulkkinen PO, Paavolainen P, Nevalainen JK (2001) The Finnish Arthroplasty Register: report of the hip register. Acta Orthop Scand 72(5):433–441CrossRefPubMedGoogle Scholar
  16. 16.
    Blacha J, Bednarek A, Buma P (2001) Osteolysis around HA-coated press-fit hip prosthesis. Presented at the 5th EFORT congress, Rhodes, Greece, JuneGoogle Scholar
  17. 17.
    Giannikas KA, Din R, Sadiq S, Dunningham TH (2002) Medium-term results of the ABG total hip arthroplasty in young patients. J Arthroplast 17(2):184–188CrossRefPubMedGoogle Scholar
  18. 18.
    Rogers A, Kulkarni R, Downes EM (2003) The ABG hydroxyapatite-coated hip prosthesis: one hundred consecutive operations with average 6-year follow-up. J Arthroplast 18(5):619–625CrossRefPubMedGoogle Scholar
  19. 19.
    Morscher EW, Hefti A, Aebi U (1998) Severe osteolysis after third-body wear due to hydroxyapatite particles from acetabular cup coating. J Bone Jt Surg Br 80(2):267–272CrossRefGoogle Scholar
  20. 20.
    Witkiewicz H, Vidovszky T, Turner RT, Rock MG, Morrey BF, Bolander ME (1993) Fate of ultrahigh molecular weight polyethylene (UHMW-PE) wear debris in patients with hip implants. Tech Orthop 8(4):254–261PubMedCrossRefGoogle Scholar
  21. 21.
    Poole CE, Patil SS, d'Lima DD, Colwell CW (2005) Early follow-up for a hybrid total hip arthroplasty using a metal-backed acetabular component designed to reduce “backside” polyethylene wear. HSSJ 1(1):31–34CrossRefGoogle Scholar
  22. 22.
    Charnley J, Halley DK (1975) Rate of wear in total hip replacement. Clin Orthop 112:170–179PubMedGoogle Scholar
  23. 23.
    Ilchmann T, Mjoberg B, Wingstrand H (1995) Measurement accuracy in acetabular cup wear. Three retrospective methods compared with Roentgen stereophotogrammetry. J Arthroplast 10(5):636–642CrossRefGoogle Scholar
  24. 24.
    Sarmiento A, Gruen TA (1985) Radiographic analysis of a low-modulus titanium-alloy femoral total hip component. Two to six-year follow-up. J Bone Jt Surg Am 67(1):48–56Google Scholar
  25. 25.
    DeLee JG, Charnley J (1976) Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop 121:20–32PubMedGoogle Scholar
  26. 26.
    Johnston RC, Fitzgerald RH, Harris WH, Poss R, Muller ME, Sledge CB (1990) Clinical and radiological evaluation of total hip replacement. A standard system of terminology for reporting results. J Bone Jt Surg Am 72:161–168Google Scholar
  27. 27.
    Lewinnek GE, Lewis JL, Tarr R, Compere CL, Zimmerman JR (1978) Dislocations after total hip-replacement arthroplasties. J Bone Jt Surg Am 60(2):217–220Google Scholar
  28. 28.
    Duffy P, Sher JL, Partington PF (2004) Premature wear and osteolysis in an HA-coated uncemented total hip arthroplasty. J Bone Jt Surg Br 86(1):34–38Google Scholar
  29. 29.
    Insley G, Jones E, Streicher R (2001) Risk factors for wear of first generation modular acetabular cups. 5th EFORT congress, Rhodes, Greece, June 3–7Google Scholar
  30. 30.
    Muratoglu OK, Greenbaum ES, Bragdon CR, Jasty M, Freiberg AA, Harris WH (2004) Surface analysis of early retrieved acetabular polyethylene liners—a comparison of conventional and highly crosslinked polyethylenes. J Arthroplast 19(1):68–77CrossRefGoogle Scholar
  31. 31.
    Smith SL, Ash HE, Unsworth A (2000) A tribological study of UHMWPE acetabular cups and polyurethane compliant layer acetabular cups. J Biomed Mater Res 53(6):710–716CrossRefPubMedGoogle Scholar
  32. 32.
    Wirtz DC, Schopphoff E, Weichert D, Niethard FU (2001) Stretched polyethylene (UHMWPE)—a new substance modification for minimizing wear in artificial knee joint replacement. Biomed Tech 46(12):338–342CrossRefGoogle Scholar
  33. 33.
    Streicher RM, Thomsen M (2003) Polyethylene as an implant material. Orthopade 32(1):23–31CrossRefPubMedGoogle Scholar

Copyright information

© Hospital for Special Surgery 2006

Authors and Affiliations

  • Jörg Axel Karl Ohnsorge
    • 1
  • Jack Davis
    • 2
  • Uwe Maus
    • 1
  • Muharrem Saklak
    • 3
  • Markus Weisskopf
    • 1
  • Dieter Christian Wirtz
    • 1
  1. 1.Department of Orthopaedic SurgeryUKA, RWTH-University of AachenAachenGermany
  2. 2.Knee & Hip Service, Hospital for Special SurgeryNew YorkUSA
  3. 3.Department of General SurgeryUKA, RWTH-University of AachenAachenGermany

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