title: Loosening of massive proximal femoral cemented endoprostheses. Radiographic evidence of loosening mechanism.
abstract: A review of the radiographs of 24 patients with massive proximal femoral cemented tumor endoprostheses revealed a repetitive radiographic sequence that culminated in implant loosening. The initial step was osteolysis of the proximal femur at the bone-prosthesis junction (13 of 24 cases, 54%). The osteolysis then progressed into the adjacent periprosthetic bone-cement interface as a radiolucent line (5 of 24 cases, 21%), followed by extension along the stem, culminating in implant loosening (4 of 24 cases, 17%). Two prostheses (8%) have required revision for loosening. The proximal osteolysis was noted prior to the appearance of progressive periprosthetic radiolucent lines in 11 patients and simultaneously in 2 but never followed periprosthetic radiolucent lines (P < .05). These findings are consistent with loosening by debris-induced osteolysis. This loosening sequence, confirming previous observations of cemented component loosening, should encourage efforts to prevent or delay the onset of this sequence.
authors.affiliation: Department of Orthopaedic Surgery, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1070, USA.
authors.forename: W G
authors.initials: WG
authors.lastname: Ward
authors.forename: K S
authors.initials: KS
authors.lastname: Johnston
authors.forename: F J
authors.initials: FJ
authors.lastname: Dorey
authors.forename: J J
authors.initials: JJ
authors.lastname: Eckardt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002484:Cementation; D002813:Chondrosarcoma / Q000601:surgery; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery; D005269:Femur / Q000601:surgery*; D005354:Fibrosarcoma / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000209:etiology; D012516:Osteosarcoma / Q000601:surgery; D011475:Prosthesis Failure; D012509:Sarcoma / Q000601:surgery; D012983:Soft Tissue Neoplasms / Q000601:surgery