title: A retrieval study of capital hip prostheses with titanium alloy femoral stems.
abstract: We have examined 26 retrieved, failed titanium-alloy femoral stems. The clinical details, radiological appearances and the histology of the surrounding soft tissues in each patient were also investigated. The stems were predominantly of the flanged design and had a characteristic pattern of wear. A review of the radiographs showed a series of changes, progressive with time. The first was lateral debonding with subsidence of the stem. This was followed by calcar resorption and fragmentation or fracture of the cement. Finally, osteolysis was seen, starting with a radiolucency at the cement-bone interface and progressing to endosteal cavitation. Three histological appearances were noted: granulomatous, necrobiotic and necrotic. We suggest that an unknown factor, possibly related to the design of the stem, caused it to move early. After this, micromovement at the cement-stem interface led to the generation of particulate debris and fracture of the cement. A soft-tissue reaction to the debris resulted in osteolysis and failure of fixation of the prostheses.
authors.affiliation: Medical and Biological Engineering Group, Leeds, England.
authors.forename: L R
authors.initials: LR
authors.lastname: Mcgrath
authors.forename: D L
authors.initials: DL
authors.lastname: Shardlow
authors.forename: E
authors.initials: E
authors.lastname: Ingham
authors.forename: M
authors.initials: M
authors.lastname: Andrews
authors.forename: J
authors.initials: J
authors.lastname: Ivory
authors.forename: M H
authors.initials: MH
authors.lastname: Stone
authors.forename: J
authors.initials: J
authors.lastname: Fisher
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D006097:Granulation Tissue / Q000473:pathology; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010014:Osteolysis; D012086:Reoperation; D014025:Titanium
chemical_list: D014025:Titanium