Prevention of loosening in total hip replacements using guided bone regeneration

The aim of this study was to prevent wear debris from reaching the interface of the acetabular cup and femoral component by using a partially occlusive expanded polytetrafluoroethylene membrane. This membrane initially acted as a physical seal, which became incorporated by bone and soft tissue, forming a secondary biologic seal, preventing loosening. An animal model was developed to test the hypothesis. The model replicated the mechanisms of loosening where the effects of wear debris were studied. Using femoral heads with the appropriate roughness, a goat model produced the radiologic and histologic presentation of loosening as observed in total hip replacements in humans. Loosening was assessed by measurement of the radiolucent lines, and was attributed to wear debris by histologic investigation. The expanded polytetrafluoroethylene membrane prevented acetabular implant loosening to a statistical significance of 0.02 in a blinded assessment when compared with the control groups. Loosening of the first 5 mm of the proximomedial aspect of the femur also was prevented. The authors of the current study prevented wear particle-induced osteolysis in the acetabular component by using an expanded polytetrafluoroethylene membrane to seal the bone-cement interface.