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Journal of Bone and Joint Surgery - British Volume, Vol 83-B, Issue 8,
1195-1201.
doi: 10.1302/0301-620X.83B8.9874 Copyright © 2001 by British Editorial Society of Bone and Joint Surgery A retrieval study of Capital hip prostheses with titanium alloy femoral stemsL. R. McGrath, FRCS, Research Fellow in Orthopaedic Surgery; and D. L. Shardlow, FRCS, Specialist Registrar in Orthopaedic SurgeryDepartment of Orthopaedic Surgery, St James’s University Hospital, Beckett Street, Leeds LS9 7TF, UK. E. Ingham, PhD, Reader in Microbiology The Old Medical School, University of Leeds, Thoresby Place, Leeds LS2 9NL, UK. M. Andrews, FRCS, Consultant Orthopaedic Surgeon Scarborough and Northeast Yorkshire Healthcare Trust, Woodlands Road, Scarborough YO12 6QL, UK. J. Ivory, FRCS, Consultant Orthopaedic Surgeon Princess Margaret Hospital, Okus Road, Swindon SN1 4JU, UK. M. H. Stone, FRCS Ed, Consultant Orthopaedic Surgeon The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK. J. Fisher, DEng, Professor of Mechanical Engineering Department of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK. Correspondence should be sent to L. R. McGrath at 49 Tapton Crescent Road, Broomhill, Sheffield S10 5DB, UK. We have examined 26 retrieved, failed titanium-alloy femoral stems. The clinical details, radiological appearances and the histology of the surrounding soft tissues in each patient were also investigated. The stems were predominantly of the flanged design and had a characteristic pattern of wear. A review of the radiographs showed a series of changes, progressive with time. The first was lateral debonding with subsidence of the stem. This was followed by calcar resorption and fragmentation or fracture of the cement. Finally, osteolysis was seen, starting with a radiolucency at the cement-bone interface and progressing to endosteal cavitation. Three histological appearances were noted: granulomatous, necrobiotic and necrotic. We suggest that an unknown factor, possibly related to the design of the stem, caused it to move early. After this, micromovement at the cement-stem interface led to the generation of particulate debris and fracture of the cement. A soft-tissue reaction to the debris resulted in osteolysis and failure of fixation of the prostheses. This article has been cited by other articles:
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