The mechanism of loosening of cemented acetabular components in total hip arthroplasty. Analysis of specimens retrieved at autopsy

Late aseptic loosening of cemented acetabular components is governed by the progressive, three-dimensional resorption of the bone immediately adjacent to the cement mantle. This process begins circumferentially at the intraarticular margin and progresses toward the dome of the implant. Evidence of b...

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Bibliographic Details
Published in:	Clinical orthopaedics and related research no. 274; p. 60
Main Authors:	Schmalzried, T P, Kwong, L M, Jasty, M, Sedlacek, R C, Haire, T C, O'Connor, D O, Bragdon, C R, Kabo, J M, Malcolm, A J, Harris, W H
Format:	Journal Article
Language:	English
Published:	United States 01-01-1992
Subjects:	Acetabulum - diagnostic imaging Acetabulum - pathology Aged Aged, 80 and over Autopsy Biomechanical Phenomena Bone Cements Bone Resorption - diagnostic imaging Bone Resorption - etiology Bone Resorption - pathology Female Foreign-Body Migration - complications Foreign-Body Reaction - complications Foreign-Body Reaction - etiology Foreign-Body Reaction - immunology Hip Prosthesis Humans Macrophages Male Polyethylenes - adverse effects Prosthesis Failure Radiography
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Summary:	Late aseptic loosening of cemented acetabular components is governed by the progressive, three-dimensional resorption of the bone immediately adjacent to the cement mantle. This process begins circumferentially at the intraarticular margin and progresses toward the dome of the implant. Evidence of bone resorption at the cement-bone interface was present even in the most well-fixed implants before the appearance of lucent lines on standard roentgenographic views. The mechanical stability of the implant was determined by the three-dimensional extent of bone resorption and membrane formation at the cement-bone interface. The leading edge of the membrane is a transition zone from regions of membrane interposition between the cement and the bone to regions of intimate cement-bone contact. Histologic analysis revealed that progressive bone resorption is fueled by small particles of high density polyethylene (HDP) migrating along the cement-bone interface and bone resorption occurs as a result of the macrophage inflammatory response to the particulate HDP. Evidence in support of a mechanical basis for failure of fixation was lacking. The mechanism of late aseptic loosening of a cemented acetabular component is therefore biologic in nature, not mechanical. This is exactly opposite to the mechanism of loosening on the femoral side of a cemented total hip replacement, which is mechanical in nature.
ISSN:	0009-921X
DOI:	10.1097/00003086-199201000-00009