The value of postmortem retrievals in the analysis of long-term, well-functioning cemented femoral stems

Multiple sections from long-term, low-friction bilateral Charnley prostheses harvested from two patients who died 20 and 22 years after the primary implantation were studied. All sections showed generally sound mechanical integrity at both the cement-bone and cement-metal interfaces, in spite of localized evidence of cement fracture and debonding. The host tissues showed no clear evidence of an adverse biologic response toward the implant. These findings aided in the delineation of the sequence of biologic and mechanical events that lead to prosthesis failure. They suggest that if the apparently unavoidable mechanical deterioration of cemented implants can be limited by good fixation between the host and prosthesis, then disastrous biologic events, such as osteolysis, may be avoided, and long-term function, preserved.