For comparison of hip endoprostheses with AI203 combinations of the gliding surfaces with other material combinations, pseudocapsules and soft tissue membranes around hip endoprostheses retrieved at revision surgery or at autopsy were histologically investigated. In all tissue specimens around loosened prostheses, ceramic wear particles were found, in 50% of cases high-grade ceramic wear was seen. In contrast, only half of the autopsy cases revealed ceramic wear. Cases with AI203-AI203 combinations showed less villdus transformation of the synovial tissue, a thinner synovial layer and reduced necroses in comparison to AI203-polyethylene and metal-polyethylene combinations. These differences appeared more pronounced in the autopsy cases. The result of this study confirm the hypothesis, that a high ceramic wear rate in loosened prostheses develops mainly as a consequence of loosening. For that reason, biologically fixation of implants with spongious structured surfaces and without bone cement fixation seems a logical consequence. Modular systems are necessary not only for stem and ball, but also for the acetabular component of the hip endoprostheses.

The marrow-cavities of several human femora were cleaned and filled with plastics; the femoral component design was developed based on these moulds. Different sizes of the stem were obtained by scaling down the biggest mould in steps of 10%. The stem has an oval cross-section and is twisted similar to the form of the marrow-cavity; therefore different designs for the left and right femur are necessary. As the marrow-cavity of the femur tapers down to the middle of the shaft the length of the prosthetic stem cannot be selected arbitrarily. The stem must end above the narrowest site of the cavity. Data are presented. To avoid disadvantageous frictional stresses between the collar of the prosthesis and the plane of resection of the femoral neck both must be aligned perpendicular to the most common direction of the load of the hip joint. Therefore a step-like osteotomy of the femoral neck becomes necessary without disturbing the calcar femorale instead of an inclined osteotomy. A firm contact between the femoral wall and the collar, which forms an angle of 64 degrees with the axis of the femoral shaft, guarantees that only small frictional stresses occur between collar and femoral cortex if the load of the hip joint varies within the physiological range. A set of ceramic femoral heads with three different conical borings yield different lengths of the neck of the prosthesis. Independent of which femoral head and which size of prosthesis are chosen the direction of the maximum hip load in any case thrusts the contact area between collar and femoral wall. Thus dangerous tilting moments round the medial calcar femorale do not occur, the incidence of a fracture of the prosthesis shaft is therefore reduced. After implantation of the anatomically designed femoral component both remodeling and resorption of the calcar femorale are observed. This reaction is independent of the kind of fixation, i.e. if a smooth stem was fixed with cement or a stem with a porous, cancellous bone-like metallic surface was implanted without cement fixation.(ABSTRACT TRUNCATED AT 250 WORDS)

Pseudocapsules of artificial hip joints with ceramic- and metal on polyethylene combination of the articulating surfaces from 126 revision arthroplasties and 41 autopsies were studied histologically with semiquantitative evaluation of the polyethylene wear. The results were compared with reports of laboratory tests in the literature. We found in the autopsy specimens as well as in the biopsies from revision arthroplasties of prostheses implanted for 4 to 8 years three times less polyethylene wear particles released from the ceramic on polyethylene prostheses. The newly established synovium surrounding prostheses with ceramic heads appeared 20% reduced in thickness with minor villous transformation. Different types of metal on polyethylene prostheses revealed no differences in wear behaviour with the exception of the bipolar prostheses which showed a markedly increased polyethylene wear.

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