Incidence and mechanism of failure of cemented acetabular component in total hip arthroplasty

Abstract

Clinical results today seem to suggest that acrylic cement is crucial in producing immediate and reproducible results of pain-free joints following total hip replacement. Proper application by the use of contemporary techniques may be suitable in most conditions requiring hip replacement. The incidence of acetabular failure in a specific group of patients at risk may warrant experimentation by the use of a noncemented system. The mechanism of failure of low-friction arthroplasty may be multifaceted, but our experience indicates that the mechanisms of failure of the acetabulum have been due to excessive deepening and expansion of the acetabulum, once thought to be fundamental to the procedure. A rudimentary technique of cement pressurization, both in the femur and in the acetabulum, also may have played a part in late failures of this procedure. Early demarcation at the cement-bone interface was prevalent in young and active or heavy individuals. Demarcation and loosening were time-dependent phenomena. Demarcation and loosening also appeared with the aging process and increased osteopenia. A higher incidence of loosening also was observed in young and light-weight individuals, with presumably increased elasticity of the pelvic bone.