Osteolysis after Charnley primary low-friction arthroplasty. A comparison of two matched paired groups.
We reviewed 249 consecutive Charnley primary low-friction arthroplasties in 191 patients performed by one surgeon using a transtrochanteric approach at a minimum follow-up of ten years. Of these, 37 hips in 32 patients showed osteolysis and were compared with 41 hips in 37 matched patients with no osteolysis. We assessed in each case the wear rate, stability of the prosthesis, acetabular angle, socket angle, thickness of the acetabular and femoral cement mantle, canal flare index, femoral score, stem alignment, implant:canal ratio and stem:canal ratio. We found that a high rate of wear, component instability and osteolysis were associated. Osteolysis was three times more common in men than in women. Factors which reduced osteolysis were cement mantles of 6 mm at the acetabulum and of 3 mm in all zones of the femur, a stem:canal ratio of 60% to 70% and an implant:canal ratio of over 99%. The overall incidence of osteolysis was 14.9% but when these technical criteria were met, the incidence was 5.2%. This suggests that careful technique can dramatically reduce the risk of this complication.
Department of Orthopaedic Surgery, Columbia Presbyterian Medical Center and New York Orthopaedic Hospital, NY 10032, USA.
R P
RP
Joshi
N S
NS
Eftekhar
D J
DJ
McMahon
O A
OA
Nercessian
D000077:Acetabulum / Q000473:pathology* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001843:Bone Cements / Q000737:chemistry; D016022:Case-Control Studies; D005260:Female; D005269:Femur / Q000473:pathology* / Q000601:surgery; D005500:Follow-Up Studies; D017276:Friction; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010014:Osteolysis / Q000209:etiology* / Q000517:prevention & control; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012307:Risk Factors; D012737:Sex Factors; D013499:Surface Properties
D001843:Bone Cements