Updated: Jul 25, 2026

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
E Engelbrecht1, G von Foerster, G Delling
1Endo-Klinik, Hamburg, Germany.
This study examined the use of Ionogran, a granulated form of glass ionomer cement, in hip revision surgeries. Forty-five patients received this material mixed with homologous bone between 1991 and 1994. Forty-two patients were followed up for an average of 42 months. Ten patients experienced early reloosening of the acetabular component within 30 months. Histological analysis revealed high levels of aluminium in surrounding tissues, which inhibited bone mineralisation. Serum aluminium levels were also elevated. These findings suggest that the material's toxicity may contribute to implant failure. The authors do not recommend further use of Ionogran in orthopedic surgery.
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Area of Science:
Background:
Orthopedic surgeons often rely on biocompatible materials to secure implants and promote bone healing. Prior research has shown that materials like bone cement are commonly used in revision arthroplasty. However, the long-term effects of certain cements remain unclear. No prior work had resolved the potential toxicity of ionomer-based cements in joint revision surgeries. This gap motivated the investigation into the use of Ionogran, a granulated form of glass ionomer cement. The researchers aimed to assess its role in preventing reloosening after hip revision procedures. Histological and serum data were collected to evaluate tissue response. The study's findings challenge assumptions about the material's safety profile. These results provide new insights into the risks associated with this cement in orthopedic applications.
Purpose Of The Study:
The study aimed to evaluate the clinical and biological outcomes of using Ionogran in hip revision surgeries. Surgeons used this granulated cement mixed with homologous bone as a bone substitute. The primary goal was to determine if the material could prevent reloosening of arthroplasty components. The researchers also sought to assess the material's biocompatibility. They monitored patients for a mean follow-up of 42 months. Histological and serum analyses were conducted to detect any adverse effects. The study focused on the acetabular component's stability and tissue response. The findings address uncertainties about the material's suitability for orthopedic use.
The study found that 10 out of 42 patients experienced early reloosening of the acetabular component within 30 months.
Histological analysis revealed large aluminium deposits in connective tissue and inhibited bone mineralisation.
The granulated cement was mixed with homologous bone to serve as a bone substitute during revision arthroplasty.
The study proposes that the material's biocompatibility is questionable due to toxic effects from aluminium deposits.
Main Methods:
The study involved 45 patients undergoing hip revision surgery for aseptic loosening. Ionogran was used in granulate form mixed with homologous bone. Surgeons implanted the material during revision procedures between 1991 and 1994. Forty-two patients were followed up for a mean of 42 months. Clinical outcomes were assessed for reloosening of the acetabular component. Histological examination was performed on tissue samples from the implant site. Serum levels of aluminium were measured to detect toxicity. The researchers analyzed the relationship between material use and reloosening rates.
Main Results:
Ten patients experienced early reloosening of the acetabular component within 30 months. Histological analysis revealed large aluminium deposits in connective tissue and bone. Osteoblastic function and bone mineralisation were significantly inhibited. Serum aluminium levels were elevated in affected patients. The high local concentration of aluminium caused toxic damage at the bone interface. This toxicity likely contributed to the increased reloosening rate observed. The findings suggest that the material's biocompatibility is questionable. The study does not support continued use of Ionogran in orthopedic surgery.
Conclusions:
The study's findings indicate that Ionogran may not be biocompatible in orthopedic applications. The material's use was associated with early reloosening of the acetabular component. Histological and serum data suggest toxic effects from aluminium deposits. These effects likely impaired bone healing and implant stability. The authors propose that the material's toxicity is a key factor in the observed outcomes. The high reloosening rate challenges assumptions about the material's suitability. The study does not recommend further use of Ionogran in revision arthroplasty. The findings call for caution in selecting materials for bone surgery.
The mean follow-up period was 42 months for the 42 patients included in the study.
The authors do not recommend continuation of Ionogran's use in orthopedic surgery due to observed toxicity.