STP1144

    Endosteal Osteolysis Around Well-Fixed Porous-Coated Cementless Femoral Components

    Published: Jan 1992


      Format Pages Price  
    PDF Version (144K) 7 $25   ADD TO CART
    Complete Source PDF (6.5M) 7 $65   ADD TO CART


    Abstract

    Seventeen cases of focal endosteal femoral osteolysis around cementless porouscoated femoral components of total hip replacements that were judged not to be loose on the radiographs were identified and analyzed. Fourteen of these cases were from a retrospective review of 474 cementless total hip replacements with a minimum two-year follow-up done by the authors. The incidence of the osteolysis was approximately 3% for femoral components made of both titanium-based alloys and cobalt-chrome-based alloys.

    Four of the patients underwent reoperations for osteolysis. All four femoral components were found to be rigidly fixed to the skeleton at surgery. Three of these showed extensive bony ingrowth into the porous coatings on histology. The tissue in the region of osteolysis had a fibrous stroma. However, it contained focal aggregates of macrophages and rare giant cells. On light microscopy, evidence of fine intracellular particulate polyethylene and metallic debris was found in three of the cases. In the fourth, there was a fine fibrous membrane lining a cystic cavity. Although the tissue in the fourth case contained occasional macrophages, foreign material could not be identified on light microscopy. On electron microscopy, however, fine electron-dense particles consistent with metal were noted within the macrophages of this case.

    Although these findings represent a small number of cases, they caution against the assumption that femoral osteolysis can be eliminated by using uncemented components. The precise cause for the osteolysis around uncemented porous-coated femoral components is not known. However, it seems that particulate debris from implanted biomaterials, such as metal and or polyethylene, seems to play an important role in the production of osteolysis around prosthetic components. The debris is much smaller and less frequent than that previously observed with cemented components.

    Keywords:

    particulates, implants, bone loss, total hip arthroplasty, foreign-body reaction


    Author Information:

    Jasty, M
    Assistant professor of orthopaedics, and professor and chief, Massachusetts General Hospital, Boston, MA

    Maloney, WJ
    Orthopaedic surgeon, Palo Alto Medical Clinic, Palo Alto, CA

    Harris, WH
    Assistant professor of orthopaedics, and professor and chief, Massachusetts General Hospital, Boston, MA

    Galante, JO
    Professor and chairman, Luke's Medical Center, Chicago, IL

    Callaghan, JJ
    Assistant professor, University of Iowa, Iowa City, IA


    Paper ID: STP14852S

    Committee/Subcommittee: F04.21

    DOI: 10.1520/STP14852S


    CrossRef ASTM International is a member of CrossRef.