Aseptic loosening in total hip arthroplasty secondary to osteolysis induced by wear debris from titanium-alloy modular femoral heads.
Since 1984, we have used components made of titanium alloy for total joint arthroplasty. Recently, two patients needed revision hip arthroplasty, approximately three years after the initial procedure, because of aseptic loosening secondary to severe osteolysis that had been induced by metallic debris. Although implants made of titanium alloy have many favorable qualities--most importantly, superb biocompatibility--the alloy is more susceptible to wear by particles of acrylic cement and tends to generate more polyethylene wear than do components made of stainless steel or chromium-cobalt. A new process of implanting ions has reportedly improved resistance to wear as well as fatigue properties and has enhanced the resistance to corrosion of the implants. Although, to our knowledge, only in vitro studies of this process have been reported to date, we recommend avoiding the use of components made of titanium alloy in which ions have not been implanted. We suggest considering the possibility of osteolysis secondary to appreciable metallic debris in patients who have aseptic loosening of titanium-alloy components that were not implanted with ions.
Lombardi
A V
AV
Saint Anthony Medical Center, Columbus, Ohio.
Mallory
T H
TH
Vaughn
B K
BK
Drouillard
P
P
D000328:Adult; D000497:Alloys / Q000009:adverse effects*; D003343:Corrosion; D005260:Female; D005270:Femur Head; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology*; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D013583:Synovial Membrane / Q000473:pathology; D014025:Titanium / Q000009:adverse effects*
D000497:Alloys; D014025:Titanium