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Osteolysis around uncoated polyethylene acetabular cups

A seven- to nine-year follow-up of 79 hips

Ostéolyse autour de cupules acétabulaires de polyéthylène sans revêtement

Etude suivie sur 7 à 9 ans de 79 hanches

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Abstract

From 1983 to 1985, we performed 105 primary hip replacements in 92 osteoarthritic patients, using a non-cemented uncoated RM polyethylene cup. After a follow-up of 8.2 (7.0–9.0) years, 12 patients had died, five sockets had been revised for loosening and three for dislocation, three patients had been lost to follow-up, and three had been excluded due to severe general illnesses.

The remaining 66 patients with 79 hip replacements were reviewed clinically and by radiography, which showed osteolytic foci, mean size 13×18 mm, around 17 acetabular sockets mostly around the superior dome of the cup. Osteolytic foci were also seen around 10 femoral stems, and they were significantly more frequent in the 12 cases, where the socket had migrated.

After an exclusion of 11 patients due to a loose stem (one revised) and eight for other illnesses, an excellent or good overall functional outcome was seen in 51% of the remaining 61 hips, a fair outcome in 20% and a poor outcome in 29%. The influence of acetabular pathology on pain and function seemed to be slight.

The non-cemented uncoated polyethylene socket involves over time, a high rate of osteolysis and migration, which also endangers the fixation of the stem. These phenomena do not necessarily give symptoms. Regular radiographic reviews are therefore essential. The socket should be exchanged if the stem is revised.

Résumé

De 1983 à 1985, nous avons réalisé 105 remplacements primaires de hanches chez 92 patients arthritiques, en utilisant une cupule de polyéthylène RM non cimentée et sans revêtement. Après un suivi de 8,2 (7,0–9,0) années, 12 patients étaient décédés, cinq cupules avaient été perdues de vue et trois avaient été exclues à cause d’une sévère maladie.

Les 66 patients restants avec 70 arthroplasties totales de hanche subirent un examen clinique et radiographique. A l’examen radiographique furent découverts des foyers d’ostéolyse d’une taille moyenne de 13 mm sur 18 mm autour 17 cupules acétabulaires, principalement autour de son dôme supérieur. Des foyers d’osteolyse furent aussi vus autour de 10 tiges fémorales et ils étaient significativement plus fréquents dans les 12 cas où la cupule avait migré.

Après exclusion de 11 patients ayant eu un descellement de la tige fémorale (dont l’un a subi un contrôle) et de huit à cause d’une autre maladie, un résultat fonctionel global excellent ou bon fut observé chez 51 % des 61 hanches restantes, un résultat acceptable chez 20 % et un mauvais résultat chez 29 %. L’influence de la pathologie acétabulaire sur la douleur ou la fonction semble être faible.

La cupule en polyéthylène non cimentée sans rêvetement subit avec le temps un haut pourcentage d’ostéolyse et de migration, qui fragilise aussi la fixation de la tige. Ces phénomènes ne sont pas toujours symptomatiques. Des examens radiographiques réguliers sont de ce fait essentiels. La cupule doit être changée si la tige est changée.

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Authors and Affiliations

  1. Department of Surgery, University Hospital, SF-90220, Oulu, Finland

    T. J. Niinimäki, M. M. Ruuskanen & P. K. A. Jalovaara

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  1. T. J. Niinimäki
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  2. M. M. Ruuskanen
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  3. P. K. A. Jalovaara
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Niinimäki, T.J., Ruuskanen, M.M. & Jalovaara, P.K.A. Osteolysis around uncoated polyethylene acetabular cups. Eur J Orthop Surg Traumatol 5, 113–118 (1995). https://doi.org/10.1007/BF02716252

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