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Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty

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Abstract

Purpose

The use of inappropriate cementation techniques has been suggested as an adverse factor for the long-term survival of hip-resurfacing arthroplasty. Inadequate initial fixation, thermal osteonecrosis and interface biological reactions are possible causes of failure. We analysed morphological changes associated with the cementation technique in a large collection of retrieved femoral components.

Methods

One hundred and fifty femoral components (mean time to failure of 8.3 months ± 11.0) obtained at revision surgery were analysed morphometrically and histopathologically. Cement mantle and penetration were quantified in six different regions of interest. Histopathological analysis of the bone–cement interface was performed on undecalcified processed bone tissue.

Results

The vast majority of the cases differed substantially from laboratory-based cement-penetration depth recommendations. Fifty-nine cases had a fibrous membrane at the cement–bone interface. This membrane was significantly thicker in cases with osteonecrosis compared to cases viable bone.

Conclusions

Our results demonstrate that most failures were cemented inappropriately. We suggest that poor cementation was an important adverse factor; however, the cause of the failures was obviously multifactorial. The thickness of the fibrous membrane at the cement–bone interface differed significantly between cases with osteonecrosis and specimens with viable bone tissue.

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Acknowledgments

We thank all cooperating orthopaedic surgeons who provided us with cases. The authors further thank Dr. Christine zu Eulenburg for conducting statistical analyses. The Hamburg Retrieval Study on Hip Resurfacing was supported by Biomet Orthopaedics (Warsaw, IN, USA), Corin Medical (Cirencester, UK), DePuy Orthopaedics International (Leeds, UK), Smith and Nephew (London, UK), and Zimmer (Warsaw).

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany

    Matthias Krause, Stefan Breer, Michael Hahn & Michael Amling

  2. Department of Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Wolfgang Rüther

  3. Biomechanics Section, TUHH Hamburg University of Technology, Denickestraße 15, 21073, Hamburg, Germany

    Michael M. Morlock

  4. Institute of Pathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Jozef Zustin

Authors
  1. Matthias Krause
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  2. Stefan Breer
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  3. Michael Hahn
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  4. Wolfgang Rüther
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  5. Michael M. Morlock
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  6. Michael Amling
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  7. Jozef Zustin
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Corresponding author

Correspondence to Michael Amling.

Additional information

Matthias Krause and Stefan Breer contributed equally to this work and share first authorship

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Krause, M., Breer, S., Hahn, M. et al. Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty. International Orthopaedics (SICOT) 36, 1333–1340 (2012). https://doi.org/10.1007/s00264-011-1464-7

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  • DOI: https://doi.org/10.1007/s00264-011-1464-7

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