Patterns of failure in the original Besser bipolar prosthesis

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Hip reconstruction

Background:

• Osteonecrosis of the femoral head (ONFH) is a debilitating condition often affecting young patients.
• Total hip arthroplasty (THA) is a common treatment for advanced ONFH.
• The Besser endoprosthesis is a specific implant used in THA.

Purpose of the Study:

• To evaluate the clinical outcomes and failure modes of the original Besser endoprosthesis in young patients with ONFH.
• To identify factors contributing to the failure of this specific hip implant.

Main Methods:

• Retrospective review of 14 original Besser endoprostheses implanted in young patients with ONFH.
• Analysis of patient records, radiographic images, and surgical notes.
• Assessment of implant survival, dislocation rates, component failure, and patient-reported pain and mobility.

Main Results:

• A high failure rate of 50% was observed in this series.
• Complications included early cup dislocation (2 hips), acetabular degeneration requiring revision (1 hip), and component disassembly (4 hips).
• Persistent vertical cup orientation was associated with component failure and was present in 3 asymptomatic hips, indicating a predisposition to future failure.

Conclusions:

• The original Besser endoprosthesis demonstrated a disappointing failure rate in this cohort of young ONFH patients.
• Component disassembly and cup failure appear linked to a persistently vertical cup orientation.
• Further investigation and caution are warranted when considering this implant for hip reconstruction.