Related Experiment Videos
Failure of total hip arthroplasty with a precoated prosthesis. 4- to 11-year results
1Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, PA, USA.
Insights
Poor cement technique in total hip arthroplasty can lead to early femoral component failure. This review highlights the risks associated with inadequate cement mantles, emphasizing improved surgical methods for better outcomes.
Area of Science:
- Orthopedic Surgery
- Biomaterials Engineering
- Clinical Research
Background:
- Early failures of femoral components in total hip arthroplasty (THA) necessitated a review.
- Hybrid cemented THA with polymethyl-methacrylate (PMMA) coated prostheses were analyzed.
Purpose of the Study:
- To investigate the causes of early femoral component failures in hybrid cemented THA.
- To identify predictors of femoral component failure and evaluate the impact of surgical techniques.
Main Methods:
- Retrospective clinical and radiographic review of 176 hybrid cemented THA cases.
- Analysis of femoral component failures, cement mantle quality, and osteolysis.
- Comparison between failed and non-failed component groups.
Main Results:
- Fifteen percent (23/154) of femoral components failed, with a mean revision time of 3.9 years.
- Poor cement mantles (Grades C/D) and distal deficiencies were significant predictors of failure.
- Osteolysis at the cement-bone interface was the primary failure mechanism.
Conclusions:
- Inadequate cement technique is a critical factor in early femoral component failure in THA.
- Techniques like centralization and centrifugation may improve clinical outcomes.
- Strengthening the cement-prosthesis interface without addressing cement mantle quality can increase failure risk.
Abstract:
A series of early femoral component failures prompted a detailed retrospective clinical and radiographic review of 176 hybrid cemented total hip arthroplasties using a polymethyl-methacrylate coated femoral prosthesis. All surgeries were performed using third generation cement techniques. Average length of followup was 6.3 years (range, 3-12 years). Twenty-one patients died, and one underwent revision surgery because of sepsis. Of the remaining 154 total hip arthroplasties, 23 (15%) of the femoral components failed (21 revised, two definitely loose). The average time to revision was 3.9 years. None of the acetabular components failed. Comparison between the failure and nonfailure groups revealed that poor cement mantles (Grades C or D) with distal cement mantle deficiencies were statistically significant predictors of femoral failure. The most common mechanism of failure was progressive, circumferential cement-bone interface osteolysis with relative preservation of the cement-metal interface. Debonding of the cement column from the prosthesis was a late finding and occurred in only 45% of failed cases. Incorporating the techniques of centralization and centrifugation significantly improved clinical results. Strengthening of the cement-prosthesis interface may magnify the deleterious effects of a poor cement mantle and predisposes the cement-bone interface to failure.