title: Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty.
abstract: OBJECTIVE
  The use of inappropriate cementation techniques has been suggested as an adverse factor for the long-term survival of hip-resurfacing arthroplasty. Inadequate initial fixation, thermal osteonecrosis and interface biological reactions are possible causes of failure. We analysed morphological changes associated with the cementation technique in a large collection of retrieved femoral components.
  
  
  METHODS
  One hundred and fifty femoral components (mean time to failure of 8.3 months±11.0) obtained at revision surgery were analysed morphometrically and histopathologically. Cement mantle and penetration were quantified in six different regions of interest. Histopathological analysis of the bone-cement interface was performed on undecalcified processed bone tissue.
  
  
  RESULTS
  The vast majority of the cases differed substantially from laboratory-based cement-penetration depth recommendations. Fifty-nine cases had a fibrous membrane at the cement-bone interface. This membrane was significantly thicker in cases with osteonecrosis compared to cases viable bone.
  
  
  CONCLUSIONS
  Our results demonstrate that most failures were cemented inappropriately. We suggest that poor cementation was an important adverse factor; however, the cause of the failures was obviously multifactorial. The thickness of the fibrous membrane at the cement-bone interface differed significantly between cases with osteonecrosis and specimens with viable bone tissue.
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Krause
authors.forename: Stefan
authors.initials: S
authors.lastname: Breer
authors.forename: Michael
authors.initials: M
authors.lastname: Hahn
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rüther
authors.forename: Michael M
authors.initials: MM
authors.lastname: Morlock
authors.forename: Michael
authors.initials: M
authors.lastname: Amling
authors.forename: Jozef
authors.initials: J
authors.lastname: Zustin
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D002484:Cementation / Q000009:adverse effects* / Q000379:methods; D019544:Equipment Failure Analysis; D005260:Female; D005269:Femur / Q000473:pathology; D005271:Femur Head Necrosis / Q000209:etiology / Q000473:pathology; D005355:Fibrosis / Q000473:pathology; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008566:Membranes / Q000473:pathology; D008875:Middle Aged; D011475:Prosthesis Failure / Q000209:etiology*; D011859:Radiography; D013997:Time Factors