Post-loosening mechanical behavior of femoral resurfacing prostheses

The survival rate of femoral surface replacements has been low relative to conventional total hip replacements. The purpose of this investigation was to determine whether the early clinical loosening can be explained by mechanical causes. Using linear and nonlinear finite element methods, the pre- and post-failure load-transfer characteristics of the femoral surface replacement were analysed, and stress patterns and relative motions at the implant/bone interface were evaluated for a particular hip-loading cycle. Using histology of revision material as a guideline, implant loosening, bone resorption and fibrous interface formation were introduced in the model and their mechanical consequences analysed. The results suggest that the high failure rates are not correlated directly with the chances for primary mechanical failure of the implant-bone interface, but rather indirectly with the sensitivity of the implant design to implant loosening and the propagation of bone resorption and fibrous tissue formation. This mechanism appears to be governed by the proliferation of relative motions between implant and bone. We conclude that the 'secondary stability' of implants in general and their capacity to obtain a stable post-loosening configuration is an important design criterion for long-term survival.