Prevalence of impingement in explanted Charnley acetabular components

Abstract

: Impingement of the femoral neck against the rim of the socket bore has often been cited as one of the contributory factors in the acetabular loosening process. However, there has been little research on its clinical prevalence or on the effects of both linear wear and the diameter of the femoral neck. With this aim in mind, 74 Charnley prostheses were examined after being removed at revision surgery and the sockets interrogated for evidence of impingement. The probability of impingement was assessed using logistic regression analysis. A strong positive association was observed between penetration depth and impingement (chi2 = 12.8; P = 0.0004) regardless of differences in the femoral neck diameter. Further, the introduction of femoral components which comprised a reduced diameter neck had a positive effect, in that the 50% probability of impingement occurred at approximately 2 mm of penetration. For those components with standard necks, the 50% probability of impingement occurred at zero mm of penetration. If impingement is a problem then a reduced diameter neck would appear to be a solution in cutting rates of long-term loosening. However, whether or not this reduction in rim damage, and therefore impingement, is clinically significant in terms of loosening can only be fully assessed from long-term survival analysis and comparison with autopsy retrieved specimens.