Mechanism of failure in hips with an uncemented, all polyethylene socket

The outcome of 32 patients with 33 primary total hip replacements performed using noncemented uncoated polyethylene acetabular cups (RM cup) with cemented titanium alloy monoblock stems (STH-2 stem) was reviewed. At a mean followup of 6.3 years (range, 6 months-10 years), the failure rate was 57%, more than 14 times higher than the rate typically seen with cemented polyethylene acetabular cups used with the STH stem. Failure was characterized by rapidly progressive acetabular or femoral osteolytic lesions that resulted in extensive bone loss, often in patients who had no symptoms. In addition to the debris that typically is generated by a metal on plastic bearing couple, an abundance of polyethylene particles of submicron size were produced at the cup-bone interface. Tissues retrieved from areas of osteolysis revealed the presence of intracellular submicron polyethylene particles in macrophages. It is recommended that patients with no symptoms who have RM noncemented, uncoated acetabular cups be followed up yearly and undergo early revision surgery when faced with osteolysis to prevent extensive bone loss.