[Clinical course of a late aseptically loosened PCA hip prosthesis shaft]

The surface of the proximal part of a PCA endoprosthesis stem in total hip replacement is structured with small beads to provide good conditions for bone ingrowth. The distal part of the stem has a smooth surface. For the mechanical fixation concept, this means anchorage of the proximal part and free axial mobility of the distal part of the prosthesis. We present a clinical case in which bone remodeling processes finally led to complete loosening of the prosthesis. The described mechanism of loosening could be reconstructed by radiological findings, bone scan, two digital subtraction arthrographies of the hip and by evaluation of the fibrous tissue formation around the stem after explanation. In this case, after an initial period of no measureable bone reactions, distal endosteal bone and proximal radiolucent space developed without loss of contact with the prosthesis. Later, a mechanical interruption between the proximal part of the prosthesis and bone occurred. There was no loosening of the distal part of the prosthesis at this time. Despite remarkable hypertrophy of the distal femoral bone, eventually the distal part of the prosthesis loosened so that a revision arthroplasty had to be performed. The described mechanism of loosening has not be proven to pertain to all such prostheses.