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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 4, 500-501.
doi: 10.1302/0301-620X.90B4.20168  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Focal femoral osteolysis after revision hip replacement with a cannulated, hydroxyapatite-coated long-stemmed femoral component

A NEW ROUTE FOR PARTICULATE WEAR DEBRIS

D. M. Rose, MRCS, Specialist Registrar, Trauma and Orthopaedic Surgery1; E. Guryel, MRCS, Specialist Registrar, Trauma and Orthopaedic Surgery2; K. J. Acton, FRCS (Tr & Orth), Consultant Orthopaedic Surgeon3; and D. W. Clark, FRCS, Consultant Orthopaedic Surgeon4

1 St Peter’s Hospital, Guildford Road, Chertsey, Surrey KT16 0PZ, UK.
2 St George’s Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK.
3 Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 7XX, UK.
4 Worthing and Southlands Hospitals NHS Trust, Lyndhurst Road, Worthing, West Sussex BN11 2DH, UK.

Correspondence should be sent to Dr D. M. Rose; e-mail: david.rose{at}doctors.org.uk

We describe a case of symptomatic focal femoral osteolysis around a screw hole distal to the hydroxyapatite-coated portion of a cannulated femoral component in a revision hip replacement. No locking screw had been inserted into this, the most proximal of the three distal holes for locking screws. The presence of polyethylene wear debris in the tissue excised from the lesion suggested that it had passed through the cannulated portion of the stem and out of the proximal unfilled distal locking hole, initiating an osteolytic reaction in an otherwise well-fixed stem. This case highlights an important design characteristic of such cannulated, uncemented femoral components. We recommend that the proximal aperture of these cannulated stems be occluded at implantation.






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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General