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Failure Mechanisms in Total Hip and Knee Arthroplasty: A Morphologic and Radiologic Study
Author(s) -
Barden B.,
Huttegger C.
Publication year - 1999
Publication title -
materialwissenschaft und werkstofftechnik
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.285
H-Index - 38
eISSN - 1521-4052
pISSN - 0933-5137
DOI - 10.1002/(sici)1521-4052(199912)30:12<746::aid-mawe746>3.0.co;2-3
Subject(s) - osteolysis , implant , medicine , prosthesis , arthroplasty , dentistry , implant failure , surgery
Failure mechanisms in hip and knee arthroplasty are controversial, as the system of bone and implant is rather complex due to permanent biological changes, inhomogeneous Young's modulus and geometry of bone. Therefore, since 1989 534 failures were retrospectively analyzed in a clinical study: mean patients' age 67,9 years, range 21–91, cemented implants = 379, non‐cemented = 155, group 1 = 286 acetabular revisions, group 2 = 165 femoral revisions and group 3 = 83 knee revisions. Results: average survivorship of implants (late loosening): group 1 = 10,2 years, group 2 = 12,1 years, group 3 = 7,3 years. The major failure mechanism of hip and knee implants in this study was revealed as loosening at the interface between bone and cement (polymethylmethacrylate) or bone and implant: group 1 = 72 %, group 2 = 53 %, group 3 = 42 %. Other mechanisms seldom occurred: Debonding at the cement / prosthesis interface: group 1 = 4 %, group 2 = 12 %, group 3 = 15 %. Crack propagation in the cement mantle: group 1 = 8 %, group 2 = 20 %, group 3 = 3 %. Severe osteolysis due to granuloma: group 1 = 11 %, group 2 = 13 %, group 3 = 2 %. A high percentage of extensive bone defects was found: defect classification according to Paprosky [20]: group 1: type 1 = 22,4 %, type 2 = 56,3 %, type 3 = 21,3 %, group 2: type 1 = 27,3 %, type 2 = 59,4 %, type 3 = 13,3 %. Defect classification according to Fitzek and Barden [10]: group 3: type 1 = 44,6 %, type 2 = 41,0 %, type 3 = 14,5 %, type 4 = 0 %. While in hip arthroplasty early loosening within five years after the preceding operation was rare, half of the knee revisions had to be performed because of early loosening due to the special complexity of knee arthroplasty. Partial atrophy of the periprosthetic bone often occurred but could not be made responsible for loosening. Loosening without local pain was noticed in 13,2 %. There was close correlation between preoperative radiographic analysis and intraoperative findings. In conclusion severe loss of bone stock without clinical symptoms in loosening of hip and knee implants should be prevented by routine radiographic controls. Circumferential disintegration is most common and the typical failure mechanism of hip and knee implants. Thus for prophylaxis of loosening special emphasis should be laid on tight connection at the interface between cement (or implant) and bone.