Cementation and interface analysis of early failure cases after hip-resurfacing arthroplasty

Abstract

Purpose The use of inappropriate cementation techniques has been suggested as an adverse factor for the long-term survival of hip-resurfacing arthroplasty. Inadequate initial fixation, thermal osteonecrosis and interface biological reactions are possible causes of failure. We analysed morphological changes associated with the cementation technique in a large collection of retrieved femoral components. Methods One hundred and fifty femoral components (mean time to failure of 8.3 months±11.0) obtained at revision surgery were analysed morphometrically and histopathologically. Cement mantle and penetration were quantified in six different regions of interest. Histopathological analysis of the bone-cement interface was performed on undecalcified processed bone tissue. Results The vast majority of the cases differed substantially from laboratory-based cement-penetration depth recommendations. Fifty-nine cases had a fibrous membrane at the cement-bone interface. This membrane was significantly thicker in cases with osteonecrosis compared to cases viable bone. Conclusions Our results demonstrate that most failures were cemented inappropriately. We suggest that poor cementation was an important adverse factor; however, the cause of the failures was obviously multifactorial. The thickness of the fibrous membrane at the cement-bone interface differed significantly between cases with osteonecrosis and specimens with viable bone tissue.

Bone Microarchitecture of the Talus Changes With Aging

“…Before further preparation, one section of each age group was exemplarily scanned by micro-CT (lCT40; SCANCO Medical AG, Bruettisellen, Switzerland) with an in vitro scanning protocol (55 kVp, 145 lA, 200-ms integration time) resulting in an isotropic voxel size of 18 lm to visualize three-dimensional bone histomorphometry. After documentation on contact radiographs, the specimens were subjected to an undecalcified infiltration process, ground to a thickness of 1 mm, and stained using a modification of the von Kossa method [13,31]. ROIs were defined by two lines: (1) running from the distal border from the inflow of the arteria sinus tarsi to the caudal end of the facies articularis navicularis; and (2) running from the distal end of the trochlea tali (facies articularis superior) to the distal end of the facies articularis calcanea posterior.…”

Effects of long-term alendronate treatment on bone mineralisation, resorption parameters and biomechanics of single human vertebral trabeculae

“…After completion of the 3D µCT measurements, the upper half of the specimens was subjected to an undecalcified infiltration process, plastic embedded, and cut into 5 µm sections. Then, the bone sections were stained using either the von-Kossa technique, toluidine blue or Goldner trichrome, as previously described (Breer et al, 2012;Krause et al, 2012a). The ratio of osteoid volume per bone volume (OV/BV, %), osteoid surface per bone surface (OS/ BS, %) and eroded surface (ES/BS, %) were assessed using an automated computer-assisted image analysing system (OsteoMeasure, OsteoMetrics, Decatur, GA, USA).…”

Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties

“…[29][30][31][32][33][34][35] Other microscopic lesions that have been observed in cases with suggested metal hypersensitivity are intraosseous lymphocyte infiltrations, 29 32 necrotising granulomas [36][37][38] with macrophages, proliferative synovitis, 32 39 and changes at the bone-cement interface, 40 particularly hyperosteoidosis of the interface bone trabeculae. 29 41 42 Because lymphocytes can be seen in virtually all periprosthetic synovial biopsies, and also other bearing couples, [43][44][45][46] we used a conservative cut-off value of more than 300 lymphocytes/HPF in order for lymphocyte infiltrates to be considered suggestive of a hypersensitivity reaction in our previous studies.…”