Failure of total hip arthroplasty with a precoated prosthesis. 4- to 11-year results

• Published in: Clinical orthopaedics and related research no. 355; p. 123
• Main Authors: Dowd, J E, Cha, C W, Trakru, S, Kim, S Y, Yang, I H, Rubash, H E
• Format: Journal Article
• Language: English
• Published: United States 01-10-1998
• Subjects: Aged; Aged, 80 and over; Arthroplasty, Replacement, Hip - instrumentation; Biomechanical Phenomena; Bone Cements - therapeutic use; Causality; Coated Materials, Biocompatible - therapeutic use; Equipment Failure Analysis; Female; Hip Prosthesis - adverse effects; Humans; Male; Osteolysis - diagnostic imaging; Osteolysis - etiology; Polymethyl Methacrylate - therapeutic use; Proportional Hazards Models; Prosthesis Design; Prosthesis Failure; Radiography; Reoperation; Retrospective Studies; Survival Analysis; Time Factors
• ISSN: 0009-921X
• DOI: 10.1097/00003086-199810000-00013

A series of early femoral component failures prompted a detailed retrospective clinical and radiographic review of 176 hybrid cemented total hip arthroplasties using a polymethyl-methacrylate coated femoral prosthesis. All surgeries were performed using third generation cement techniques. Average length of followup was 6.3 years (range, 3-12 years). Twenty-one patients died, and one underwent revision surgery because of sepsis. Of the remaining 154 total hip arthroplasties, 23 (15%) of the femoral components failed (21 revised, two definitely loose). The average time to revision was 3.9 years. None of the acetabular components failed. Comparison between the failure and nonfailure groups revealed that poor cement mantles (Grades C or D) with distal cement mantle deficiencies were statistically significant predictors of femoral failure. The most common mechanism of failure was progressive, circumferential cement-bone interface osteolysis with relative preservation of the cement-metal interface. Debonding of the cement column from the prosthesis was a late finding and occurred in only 45% of failed cases. Incorporating the techniques of centralization and centrifugation significantly improved clinical results. Strengthening of the cement-prosthesis interface may magnify the deleterious effects of a poor cement mantle and predisposes the cement-bone interface to failure.