Advertisement

Prosthetic Loosening in Total Hip Replacements

  • Murali Jasty

Abstract

Total replacement of arthritic joints with artificial metal and plastic materials has provided dramatic relief of pain and improvement in function for millions of patients with end-stage arthritis.1 It has also revolutionized the surgical treatment of arthritis for the past 30 years. Despite the enormous success of these procedures, however, aseptic loosening of the components—often associated with periprosthetic osteolysis and frequently necessitating revision surgery—remains the major problem. The THAs done in the 1970s had loosening rates of 30% to 40% by 10 years after surgery.2,3 Improvements in surgical techniques, prosthetic designs, and biomaterials1,4–6 have subsequently improved the longevity of the prosthesis, with only 3% of the femoral components and 10 percent of the acetabular components of THAs now requiring revision surgery at 10 to 15 years.7 Even though these results appear satisfactory for the vast majority of the elderly patients, continuously increasing life expectancy of the population in developed countries and demands for making these procedures available for younger, heavier, and more active patients necessitate continued investigation to extend the longevity of these procedures even further.

Keywords

Femoral Component Aseptic Loosening Acetabular Component Cement Mantle Periprosthetic Osteolysis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Harris WH, Sledge CB. Medical progress: total hip and total knee replacement. N Engl J Med. 1990;323:725–731.PubMedCrossRefGoogle Scholar
  2. 2.
    Stauffer RN. Ten year follow-up study of total hip replacement. J Bone Joint Surg Am. 1982;64:983–990.PubMedGoogle Scholar
  3. 3.
    Sutherland CJ, Wilde AH, Borden LS, Marks KE. A ten year follow-up of one hundred consecutive Muller curved-stem total hip replacement arthroplasties. J Bone Joint Surg Am. 1982;64:970–982.PubMedGoogle Scholar
  4. 4.
    Ahmed AM, Raab A, Miller JE. Metal/cement interface strength in cemented stem fixation. J Orthop Res. 1984;2: 105–118.PubMedCrossRefGoogle Scholar
  5. 5.
    Crowninshield RD, Brand RA, Johnston RC, Milroy JC. The effect of femoral stem cross-sectional geometry on cement stresses in total hip reconstruction. Orthopedics. 1980;146:71–77.Google Scholar
  6. 6.
    Engh CA, Hooten JP Jr, Zettl-Schaffer KF, Ghaffarpour M, McGovern TF, Macaling GE, et al. Porous-coated total hip replacement. Clin Orthop. 1994;298:89–96.PubMedGoogle Scholar
  7. 7.
    Mulroy RD, Harris WH. The effect of improved cementing techniques on component loosening in total hip replacement. J Bone Joint Surg Br. 1990;72:757–760.PubMedGoogle Scholar
  8. 8.
    Amstutz HC, Markolf KL, McNeice GM, Gruen TA. Loosening of total hip components: cause and prevention. In: The Hip: Proceedings of the Fourth Open Scientific Meeting of the Hip Society. St Louis, Mo: CV Mosby, Inc; 1965.Google Scholar
  9. 9.
    Harris WH, Schiller AL, Scholler JM, Freiberg RA, Scott R. Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am. 1976;58: 612–618.PubMedGoogle Scholar
  10. 10.
    Weber BG. Total hip replacement revision surgery: surgical technique and experience. Hip. 1981;XX:3–14.Google Scholar
  11. 11.
    Willert HG, Bertram H, Buchhorn GH. Osteolysis in alloarthroplasty of the hip: the role of bone cement fragmentation. Clin Orthop. 1990;258:108–121.PubMedGoogle Scholar
  12. 12.
    Burke DW, O’Connor DO, Zalenski EB, Jasty M, Harris WH. Micromotion of cemented and uncemented femoral components. J Bone Joint Surg Br. 1991;73:33–37.PubMedGoogle Scholar
  13. 13.
    Jasty M, Maloney WJ, Bragdon CR, O’Connor DO, Haire T, Harris WH. The initiation of failure in cemented femoral components of hip arthroplasties. J Bone Joint Surg Br. 1991;73:551–558.PubMedGoogle Scholar
  14. 14.
    Jasty M, Jiranek WJ, Harris WH. Acrylic fragmentation in total hip replacements and its biologic consequences. Clin Orthop. 1992;285:116–128.PubMedGoogle Scholar
  15. 15.
    Jasty M, Maloney WJ, Bragdon CR, Haire T, Harris WH. Histomorphological studies of the long-term skeletal responses to well fixed cemented femoral components. J Bone Joint Surg Am 1990;72:1220–1225.PubMedGoogle Scholar
  16. 16.
    Hodgkinson JP, Shelley P, Wroblewski BM. The correlation between the roentgenographic appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasties. Clin Orthop. 1988;228:105–109.PubMedGoogle Scholar
  17. 17.
    Barrack RI, Tanzer M, Kaltapuram SV, Harris WH. The value of contrast arthrography in assessing loosening of symptomatic uncemented total hip components. Skeletal Radiol. 1994;23:37–41.PubMedCrossRefGoogle Scholar
  18. 18.
    Hardy DC, Reinus WR, Totty WG, Deyser CK. Arthrography after total hip arthroplasty: utility of postambulation radiographs. Skeletal Radiol. 1988;17:20–23.PubMedCrossRefGoogle Scholar
  19. 19.
    Fornasier VL, Cameron HU. The femoral stem/cement interface in total hip replacement. Clin Orthop. 1976;116:248–253.PubMedGoogle Scholar
  20. 20.
    Charnley J. Low friction arthroplasty of the hip. New York: Springer-Verlag; 1979:6–7.CrossRefGoogle Scholar
  21. 21.
    Agins HJ, Alcok NW, Bansal M, et al. Metallic wear in failed titanium-alloy total hip replacements. J Bone Joint Surg Am. 1988;70:347–356.PubMedGoogle Scholar
  22. 22.
    Lombardi AV, Mallory TH, Vaughn BK, Drouillard P. Aseptic loosening in total hip arthroplasty secondary to osteolysis induced by wear debris from titanium-alloy modular femoral heads. J Bone Joint Surg Am. 1989;71: 1337–1342.PubMedGoogle Scholar
  23. 23.
    Kwong L, Tasty M, Mulroy R, Maloney W, Bragdon C, Harris WH. “Radiolucencies” in cemented femoral total hip replacements: a correlation of radiographic and histologic findings after in vivo service. J Bone Joint Surg Br. 1992;74:67–73.PubMedGoogle Scholar
  24. 24.
    Schmalzried TP, Kwong LM, Jasty M, et al. The mechanism of loosening of cemented acetabular components. Clin Orthop. 1992;274:60–78.PubMedGoogle Scholar
  25. 25.
    Athanasou NA, Quinn J, Bulstrode CJK. Resorption of bone by inflammatory cells derived from the joint capsule of hip arthroplasties. J Bone Joint Surg Br. 1992;74:57–62.PubMedGoogle Scholar
  26. 26.
    Anthony PP, Gie GA, Howie CR, Ling RS. Localised endosteal bone lysis in relation to the femoral components of cemented total hip arthroplasties. J Bone Joint Surg Br. 1990;72:971–979.PubMedGoogle Scholar
  27. 27.
    Goldring SA, Schiller AL, Roelke M, Rourke CM, O’Neill DA, Harris WH. The synovial-like membrane at the bone-cement interface in loose total hip replacements and its proposed role in bone lysis. J Bone Joint Surg Am. 1983; 65:575–584.PubMedGoogle Scholar
  28. 28.
    Goldring SR, Tasty M, Roelke M, Rourke CM, Harris WH. Factors responsible for formation of synovial-like membrane after total hip replacement (THR): its role in prosthesis loosening. Arthritis Rheum. 1985;28:S36.Google Scholar
  29. 29.
    Goldring SR, Tasty M, Roelke MS, Rourke CM, Bringhurst FR. Formation of a synovial-like membrane at the bone-cement interface: its role in bone resorption and implant loosening after total hip replacement. Arthritis Rheum. 1986;29:836–842.PubMedCrossRefGoogle Scholar
  30. 30.
    Jiranek WA, Michado M, Jasty M, et al. Production of cytokines around loosened cemented acetabular components. J Bone Joint Surg Am. 1993;75:863–879.PubMedGoogle Scholar
  31. 31.
    Santivirta S, Hoikka V, Esokola A, Konttinen YT, Paavilainen T. Aggressive granulomatous lesions in cementless total hip arthroplasty. J Bone Joint Surg Br. 1990; 72:980–984.Google Scholar
  32. 32.
    Astion DJ, Saluan P, Stulberg BN, Rimnac CM, Li S. The porous-coated anatomic total hip prosthesis: failure of the metal-backed acetabular component. J Bone Joint Surg Am. 1976;78:755–766.Google Scholar
  33. 33.
    Hedley AK, Gruen TAW, Baden LS, Hungerford DS, Haberman E, Kenna RV. Two year follow-up of the PCA noncemented total hip replacement. In: The Hip: Proceedings of the Fourteenth Open Scientific Meeting of The Hip Society. St Louis: CV Mosby, Inc; 1987:225–250.Google Scholar
  34. 34.
    Martell JM, Pierson RH, Jacobs JJ, Rosenberg AG, Maley M, Galante JO. Primary total hip reconstruction with a cementless titanium fiber coated prosthesis inserted without cement. J Bone Joint Surg Am. 1993;75:554–571.PubMedGoogle Scholar
  35. 35.
    Cameron HU. The 3–6 year results of a modular noncemented low-bending stiffness hip implant: a preliminary study. J Arthroplasty. 1993;8:239–243.PubMedCrossRefGoogle Scholar
  36. 36.
    Engh CA, Glassman AH, Suthers KE. The case for porous-coated hip implants: the femoral side. Clin Orthop. 1990;261:63–81.PubMedGoogle Scholar
  37. 37.
    Bruijn JD, Seelen JL, Feenstra RM, Hansen BE, Bernoski FP. Failure of the mecring screw-ring acetabular components in total hip arthroplasty. J Bone Joint Surg Am. 1995;77: 760–766.PubMedGoogle Scholar
  38. 38.
    Latimer HA, Lachiewicz PF. Porous-coated acetabular components with screw fixation. J Bone Joint Surg Am. 1976;78:975–981.Google Scholar
  39. 39.
    Bourne RB, Rorabeck CH, Ghazal ME, Lee MH. Pain in the thigh following total hip replacement with a porous-coated anatomic prosthesis for osteoarthrosis. J Bone Joint Surg Am. 1994;77:1464–1470.Google Scholar
  40. 40.
    Barrack RL, Jasty M, Bragdon C, Haire T, Harris WH. Thigh pain despite bone ingrowth into uncemented femoral stems. J Bone Joint Surg Br. 1992;74:507–510.PubMedGoogle Scholar
  41. 41.
    Tanzer M, Maloney WT, Tasty M, Harris WH. The Progression of femoral cortical osteolysis in association with total hip arthroplasty without cement. J Bone Joint Surg Am. In press. 1992;74:404–410.PubMedGoogle Scholar
  42. 42.
    Schmalzried TP, Tasty M, Harris WH. Periprosthetic bone loss in total hip arthroplasty: polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am. 1992;74:849–863.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Murali Jasty

There are no affiliations available

Personalised recommendations