TY - JOUR
T1 - Metallic debris in femoral endosteolysis in failed cemented total hip arthroplasties
AU - Huo, M. H.
AU - Salvati, E. A.
AU - Lieberman, J. R.
AU - Betts, F.
AU - Bansal, M.
PY - 1992
Y1 - 1992
N2 - A prospective study was undertaken to quantitate metallic and cement debris in 12 consecutive patients with femoral endosteolysis (FE) and aseptic loosening of a cemented total hip arthroplasty. The mean interval between primary and revision surgery was 9.6 years. The average time to onset of FE was 8.9 years. There were four stems each of cobalt-chromium (Co-Cr), stainless steel (SS), and titanium alloy. At revision, tissue was retrieved from FE, the femoral bone-cement pseudomembrane, and the joint pseudocapsule. Histology of these tissues was studied using light and polarized microscopy. Metal and barium levels were measured by atomic absorption spectrophotometry. A histiocytic reaction and particulate cement debris were seen in every case. Polyethylene wear debris was noted in 11 of 12 cases (92%), and metallic debris in four cases (33%). Detectable metal levels were found in the FE in all cases. Metal levels were on average 2.5 times higher in FE than in femoral pseudomembrane, and 4.2 times higher than in joint pseudocapsule. This difference was statistically significant for the Co-Cr and SS groups. Barium levels in areas of FE were on average 1.7 times and 42.4 times higher than in femoral pseudomembrane and joint pseudocapsule, respectively. The difference seen between the FE and the joint pseudocapsule tissue was significant for all three alloy groups. The authors' data demonstrated higher metal and barium levels in FE than in the other tissue sites. Polyethylene and cement debris were noted in nearly every case. Cement, polyethylene, and metallic particulate wear debris may contribute to the pathogenesis and progression of FE.
AB - A prospective study was undertaken to quantitate metallic and cement debris in 12 consecutive patients with femoral endosteolysis (FE) and aseptic loosening of a cemented total hip arthroplasty. The mean interval between primary and revision surgery was 9.6 years. The average time to onset of FE was 8.9 years. There were four stems each of cobalt-chromium (Co-Cr), stainless steel (SS), and titanium alloy. At revision, tissue was retrieved from FE, the femoral bone-cement pseudomembrane, and the joint pseudocapsule. Histology of these tissues was studied using light and polarized microscopy. Metal and barium levels were measured by atomic absorption spectrophotometry. A histiocytic reaction and particulate cement debris were seen in every case. Polyethylene wear debris was noted in 11 of 12 cases (92%), and metallic debris in four cases (33%). Detectable metal levels were found in the FE in all cases. Metal levels were on average 2.5 times higher in FE than in femoral pseudomembrane, and 4.2 times higher than in joint pseudocapsule. This difference was statistically significant for the Co-Cr and SS groups. Barium levels in areas of FE were on average 1.7 times and 42.4 times higher than in femoral pseudomembrane and joint pseudocapsule, respectively. The difference seen between the FE and the joint pseudocapsule tissue was significant for all three alloy groups. The authors' data demonstrated higher metal and barium levels in FE than in the other tissue sites. Polyethylene and cement debris were noted in nearly every case. Cement, polyethylene, and metallic particulate wear debris may contribute to the pathogenesis and progression of FE.
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U2 - 10.1097/00003086-199203000-00019
DO - 10.1097/00003086-199203000-00019
M3 - Article
C2 - 1537146
AN - SCOPUS:0026577202
SN - 0009-921X
VL - 276
SP - 157
EP - 168
JO - Clinical orthopaedics and related research
JF - Clinical orthopaedics and related research
ER -