title: Osteolysis in a cementless, second generation metal-on-metal hip replacement.
abstract: A 65-year-old man with osteoarthritis of the hip underwent a cementless total hip replacement with a modern generation, metal-on-metal bearing. Two years later the patient presented with localized osteolysis at the tip of the femoral stem. At the time of revision, the stem was found to be well-fixed. Extensive analyses of the bearing surfaces and periprosthetic tissues were done. There was minimal bearing surface wear and only small numbers of inflammatory cells, such as macrophages, in the tissues, and it was concluded that this was not a typical case of particle-induced osteolysis. All cultures and laboratory studies were negative for infection. This case report supports the multifactorial nature of osteolysis, which includes the osteolytic potential of joint fluid access to and fluid pressures within, the effective joint space.
authors.affiliation: Joint Replacement Institute at Orthopaedic Hospital, Los Angeles, CA 90007, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Beaulé
authors.forename: P
authors.initials: P
authors.lastname: Campbell
authors.forename: J
authors.initials: J
authors.lastname: Mirra
authors.forename: J C
authors.initials: JC
authors.lastname: Hooper
authors.forename: T P
authors.initials: TP
authors.lastname: Schmalzried
mesh_terms: D000368:Aged; D001843:Bone Cements; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008670:Metals / Q000009:adverse effects*; D015207:Osteoarthritis, Hip / Q000000981:diagnostic imaging / Q000601:surgery*; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D008670:Metals