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. 2005 Aug 5;29(5):268–271. doi: 10.1007/s00264-005-0667-1

Prediction of Charnley femoral stem aseptic loosening by early post-operative radiological features

M H A Malik 1,2,3,✉, N Fisher 2, J Gray 1, B M Wroblewski 1, P R Kay 1
PMCID: PMC3456642  PMID: 16082542

Abstract

We describe the association between immediate post-operative radiological appearances and early aseptic failure of total hip replacement. Sixty-three hips were entered into the aseptic failure group and 138 into the control group. Alignment of the femoral stem was not associated with failure (p=0.283). Thickness of the cement mantle was associated with failure in Gruen zones 6 (p=0.040) and 7 (p=0.003). A significant association for the presence of radiolucent lines was found for Gruen zones 3 (p=0.0001) and 5 (p=0.0001). Grade of cementation was associated with failure for Barrack grades C (p=0.001) and D (p=0.001). This study has demonstrated that easily applied radiological criteria can be used to identify ‘hip arthroplasties at risk’ from the immediate post-operative radiograph.

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Acknowledgements

M.H.A. Malik is the recipient of a Wellcome Trust Entry Level Clinical Training Fellowship, The Royal College of Surgeons of England Laming Evans Research bursary and a Zimmer-EFORT research grant.

References

  • 1.Archibeck MJ, Jacobs JJ, Roebuck KA, Glant TT. The basic science of periprosthetic osteolysis. Instr Course Lect. 2001;50:185–195. [PubMed] [Google Scholar]
  • 2.Barrack RL, Mulroy RD, Jr, Harris WH. Improved cementing techniques and femoral component loosening in young patients with hip arthroplasties: a 12-year radiographic review. J Bone Joint Surg Br. 1992;74:385–389. doi: 10.1302/0301-620X.74B3.1587883. [DOI] [PubMed] [Google Scholar]
  • 3.Chambers IR, Fender A, McCaskie AW, et al. Radiological features predictive of aseptic loosening in cemented Charnley femoral stems. J Bone Joint Surg Br. 2001;83:838–842. doi: 10.1302/0301-620X.83B6.11659. [DOI] [PubMed] [Google Scholar]
  • 4.Ebramzadeh E, Sarmiento A, McKellop HA, et al. The cement mantle in total hip arthroplasty: analysis of long-term radiographic results. J Bone Joint Surg Am. 1994;76:77–87. doi: 10.2106/00004623-199401000-00010. [DOI] [PubMed] [Google Scholar]
  • 5.Furnes O, Lie SA, Espehaug B, Vollset SE, Engesaeter LB, Havelin LI. Hip disease and the prognosis of total hip replacements. A review of 53, 698 primary total hip replacements reported to the Norwegian Arthroplasty Register 1987–99. J Bone Joint Surg Br. 2000;83:579–587. doi: 10.1302/0301-620X.83B4.11223. [DOI] [PubMed] [Google Scholar]
  • 6.Gruen TA, McNeice GM, Amstutz HC. “Modes of failure” of cemented stem-type femoral components: a radiographic analysis of loosening. Clin Ortop. 1979;141:17–27. [PubMed] [Google Scholar]
  • 7.Harris WH, McCarthy JC, O’Neill DA. Femoral component loosening using contemporary techniques of femoral cement fixation. J Bone Joint Surg Am. 1982;64:1063–1067. [PubMed] [Google Scholar]
  • 8.Iwaki H, Scott G, Freeman MA. The natural history and significance of radiolucent lines at a cemented femoral interface. J Bone Joint Surg Br. 2002;84:550–555. doi: 10.1302/0301-620X.84B4.11931. [DOI] [PubMed] [Google Scholar]
  • 9.Kelly AJ, Lee MB, Wong NS, Smith EJ, Learmonth ID. Poor reproducibility in radiographic grading of femoral cementing technique in total hip arthroplasty. J Arthroplast. 1996;11:525–528. doi: 10.1016/S0883-5403(96)80104-5. [DOI] [PubMed] [Google Scholar]
  • 10.Kobayashi A, Donnelly WJ, Scott G, Freeman MAR. Early radiological observations may predict the long-term survival of femoral hip prostheses. J Bone Joint Surg Br. 1997;79:583–589. doi: 10.1302/0301-620X.79B4.7210. [DOI] [PubMed] [Google Scholar]
  • 11.Kobayashi S, Eftekhar NS, Terayama K. Predisposing factors in fixation failure of femoral prostheses following primary Charnley low friction arthroplasty. Clin Ortop. 1994;306:73–83. [PubMed] [Google Scholar]
  • 12.Langlais F, Kerboull M, Sedel L, Ling RSM. The ‘French Paradox’. J Bone Joint Surg Br. 2003;85:17–20. doi: 10.1302/0301-620X.85B1.13948. [DOI] [PubMed] [Google Scholar]
  • 13.McCaskie AW, Brown AR, Thompson JR, Gregg PJ. Radiological evaluation of the interfaces after cemented total hip replacement. J Bone Joint Surg Br. 1995;78:191–194. [PubMed] [Google Scholar]
  • 14.Madey SM, Callaghan JJ, Olejniczak JP, et al. Charnley total hip arthroplasty with use of improved techniques of cementing: the results after a minimum of fifteen years of follow up. J Bone Joint Surg Am. 1997;79:53–64. doi: 10.1302/0301-620X.79B1.6699. [DOI] [PubMed] [Google Scholar]
  • 15.Malchau H, Herberts P, Ahnfelt L. Prognosis of total hip replacement in Sweden. Follow-up of 92,675 operations performed 1978–1990. Acta Orthop Scand. 1993;64:497–506. doi: 10.3109/17453679308993679. [DOI] [PubMed] [Google Scholar]
  • 16.Maloney WJ, Jasty M, Rosenberg A, Harris WH. Bone lysis in well fixed cemented femoral components. J Bone Joint Surg Br. 1990;72:452–456. doi: 10.1302/0301-620X.72B6.2246299. [DOI] [PubMed] [Google Scholar]
  • 17.Mullroy WF, Harris WH. Acetabular and femoral fixation 15 years after cemented total hip surgery. Clin Ortop. 1997;337:118–128. doi: 10.1097/00003086-199704000-00014. [DOI] [PubMed] [Google Scholar]
  • 18.Pacheco V, Shelley P, Wroblewski BM. Mechanical loosening of the stem in Charnley arthroplasties. J Bone Joint Surg Br. 1988;70:596–599. doi: 10.1302/0301-620X.70B4.3403604. [DOI] [PubMed] [Google Scholar]
  • 19.Ranawat CS, Deshmuck RG, Peters LE, Ulmas ME. Prediction of the long-term durability of all-polyethylene cemented sockets. Clin Ortop. 1995;317:89–105. [PubMed] [Google Scholar]
  • 20.Reading AD, McCaskie AW, Gregg PJ. The inadequacy of standard radiographs in detecting flaws in the cement mantle. J Bone Joint Surg Br. 1999;81:167–170. [PubMed] [Google Scholar]
  • 21.Ritter MA, Zhou H, Keating CM, et al. Radiological factors influencing femoral and acetabular failure in cemented Charnley total hip arthroplasties. J Bone Joint Surg Br. 1999;81:982–986. doi: 10.1302/0301-620X.81B6.9634. [DOI] [PubMed] [Google Scholar]
  • 22.Skinner JA, Todo S, Taylor M, et al. Should the cement mantle around the femoral component be thick or thin? J Bone Joint Surg Br. 2003;85:45–51. doi: 10.1302/0301-620X.85B1.13055. [DOI] [PubMed] [Google Scholar]
  • 23.Star MJ, Colwell CW, Jr, Kelman GJ, et al. Suboptimal (thin) distal cement mantle thickness as a contributory factor in total hip arthroplasty femoral component failure: a retrospective radiographic analysis favoring distal cement centralization. J Arthroplast. 1994;9:143–149. doi: 10.1016/0883-5403(94)90063-9. [DOI] [PubMed] [Google Scholar]
  • 24.Stromberg CN, Herberts P, Palmertz B, Garrellick G. Radiographic risk signs for loosening after cemented THR: 61 loose stems and 23 loose sockets compared with 42 controls. J Bone Joint Surg Br. 1996;67:43–48. doi: 10.3109/17453679608995607. [DOI] [PubMed] [Google Scholar]

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