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Osteolysis after ceramic-on-ceramic hip arthroplasty. A case report
B Borssén1, J Kärrholm, F Snorrason
1University Hospital, Department of Orthopedics, Umeå, Sweden.
Acta Orthopaedica Scandinavica
|February 1, 1991
Summary
Rheumatoid arthritis patients may experience severe bone loss around uncemented hip implants. This extensive osteolysis can lead to prosthetic fracture, even without polyethylene or cement.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Rheumatology
Background:
- Rheumatoid arthritis (RA) management often involves total hip arthroplasty.
- Ceramic-on-ceramic bearings were introduced to minimize wear debris in hip replacements.
- Uncemented prosthetic stems aim for biological fixation, avoiding bone cement complications.
Observation:
- A patient with RA received an uncemented ceramic-on-ceramic Mittelmeier total hip prosthesis.
- Extensive and rapid osteolysis (bone resorption) was observed around the prosthetic stem.
- The prosthetic stem subsequently fractured spontaneously after five years of implantation.
Findings:
- Aggressive periprosthetic bone resorption occurred despite the absence of polyethylene wear and bone cement.
- The osteolytic process was significant enough to compromise the structural integrity of the uncemented stem.
- Ceramic-on-ceramic articulation did not prevent severe bone resorption in this case.
Implications:
- Osteolysis around uncemented hip implants is a significant concern, even with advanced bearing materials.
- The risk of periprosthetic bone loss and subsequent implant failure requires further investigation.
- Alternative strategies may be needed to mitigate aggressive bone resorption in RA patients undergoing hip arthroplasty.