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Bone lysis in well-fixed cemented femoral components
W J Maloney1, M Jasty, A Rosenberg
1Massachusetts General Hospital, Boston.
The Journal of Bone and Joint Surgery. British Volume
|November 1, 1990
Summary
Focal femoral osteolysis in cemented implants, often appearing years after surgery, is linked to cement fragmentation. This fragmentation, evidenced by histology and biomechanical analysis, appears to be the primary cause of osteolysis.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Histopathology
Background:
- Focal femoral osteolysis is a concern in cemented femoral implants.
- Understanding its etiology is crucial for long-term implant survival.
Purpose of the Study:
- To investigate the causes of focal osteolysis in radiographically stable, cemented femoral implants.
- To analyze the biomechanical and histological characteristics of retrieved implant specimens.
Main Methods:
- Review of 25 cases of focal femoral osteolysis.
- Detailed biomechanical and histological analysis of three post-mortem retrieved hip specimens.
- Back-scatter scanning electron microscopy and histological examination of tissue samples.
Main Results:
- Osteolysis appeared 40-168 months post-arthroplasty, with >70% after five years.
- Osteolysis commonly occurred at cement defects or thin cement areas (Gruen zones 2, 3, 5, 6).
- Biomechanical testing and histology revealed focal cement fracture and polymethylmethacrylate particles, stimulating a histiocytic reaction.
Conclusions:
- Focal cement fragmentation, not gross loosening, is the likely stimulus for osteolysis in stable cemented femoral components.
- Particulate polymethylmethacrylate from cement fragmentation triggers a local histiocytic response, leading to osteolysis.