title: Interface abrasion between rough surface femoral stems and PMMA cement results in extreme wear volumes--a retrieval study and failure analysis.
abstract: During the loosening cascade of cemented rough femoral stems, the destruction of the mantle and the production of cement and metal wear debris occur after the loss of constraint at the interface. Two-dimensional (2D) measurements (light microscopy based morphometry on fragments of mantles and vertical scanning interferometry of femoral stems) permitted mathematical 3D-extrapolations to estimate the wear volumes. Fragments of the cement mantles available lost volumes from 0.85 mm(3) to 494.10 mm(3) (median amount of bone cement wear = 178,426 mg). The harder metal surfaces lost between 1.459 mm(3) and 5.688 mm(3) of material (the median amount of metal wear per surface = 1.504 mg/100 mm(2)). Compared to the loss of material due to the fretting of stems, the abrasion of metal, and cement in defective cement mantles produced wear volumes sufficiently high to induce osteolysis. Though the design of the femoral stem and the handling of bone cement do not represent contemporary design and clinical practice, respectively, an extremely high number of joint replacements still in daily use may be impacted by this study because of possible predicted failures. Once the processes of fragmentation, abrasion, and osteolysis have been realized, the time until revision surgery should not be unduly prolonged.
authors.affiliation: Department of Orthopaedic Surgery, Fachklinik Lorsch, Waldstrasse 13, 64653, Lorsch, Germany.
authors.forename: Gottfried Hans
authors.initials: GH
authors.lastname: Buchhorn
authors.forename: Petra
authors.initials: P
authors.lastname: Bersebach
authors.forename: Tilo
authors.initials: T
authors.lastname: Stauch
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schultz
authors.forename: Georg
authors.initials: G
authors.lastname: Köster
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D001843:Bone Cements / Q000009:adverse effects*; D019544:Equipment Failure Analysis; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D057052:Medical Device Recalls; D008875:Middle Aged; D010014:Osteolysis / Q000209:etiology / Q000473:pathology*; D019904:Polymethyl Methacrylate / Q000009:adverse effects*; D011475:Prosthesis Failure
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: PMMA bone cement; rough metal stem; rubmark; total hip replacement; volume of wear