title: Metallic shedding, surface finish changes, and extensive femoral osteolysis in the loose Spectron EF stem.
abstract: The addition of a proximal rough surface finish in the satin finish Spectron stem (Spectron EF) reportedly does not alter its clinical performance. However, we have revised 15 Spectron EF stems because of aseptic loosening and extensive femoral osteolysis at early and intermediate-term followup, raising a question as to its safety. We sought to determine which interface has aseptic failure, the presence of massive femoral osteolysis, and the consequences of loosening at the implant-cement interface in the implant's surface finish. Fifteen patients with aseptic loosening of a proximal rough surface-finished Spectron EF stem at intermediate-term followup (Group A) were compared with seven patients having revisions of the same stem for infection or recurrent dislocation but without loosening (Group B). Radiographs for Group A showed debonding at the cement-implant interface and stem subsidence in 13 hips, and severe femoral osteolysis in seven, including two pathologic periprosthetic fractures. During revision surgery, all 13 subsided stems showed a metallic stained pseudomembrane and metallic shedding with polishing of the stem surface. None of the patients in Group B who had revision surgery had these changes. Aseptic failure of the Spectron EF stem was characterized by debonding, subsidence, and metallic shedding with concomitant massive femoral osteolysis and metallosis, which is similar to conditions reported for loose, rough cemented stems, but has not been reported for the satin finish Spectron stem.
  
  
  METHODS
  Therapeutic study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Hospital for Special Surgery, New York, NY 10021, USA. gonzaleza@hss.edu
authors.forename: Alejandro
authors.initials: A
authors.lastname: González Della Valle
authors.forename: Adam
authors.initials: A
authors.lastname: Rana
authors.forename: Bryan
authors.initials: B
authors.lastname: Nestor
authors.forename: Mathias
authors.initials: M
authors.lastname: Bostrom
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Westrich
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Salvati
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D005260:Female; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007592:Joint Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008855:Microscopy, Electron, Scanning; D008875:Middle Aged; D010014:Osteolysis / Q000000981:diagnostic imaging*; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012189:Retrospective Studies; D013499:Surface Properties; D016896:Treatment Outcome