Failed hip replacements.
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Biomedical subjects
Publications and source records attributed to G A Gie.
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Four cases are described of localised endosteal bone lysis in the femur occurring in association with cemented femoral components that were not obviously 'loose' radiologically. In each, the area of lysis was shown at operation to be related directly to a region in which there was a local defect in the cement mantle surrounding the stem. Via the space between the stem and cement, such defects provide a route through which the contents of the joint cavity may reach the endosteal surface of the femur, subsequently leading to localised bone lysis, and later to frank loosening.
The satisfactory long-term radiographic appearances with the use of the collarless, smooth, polished, tapered stem encourage its continued use. With the same stem geometry shortly to become available with interchangeable heads, the capacity for the surgeon to change the bearings when polythene wear starts to become marked should address what certainly will emerge as one of the major long-term problems of total hip arthroplasty.
We report the results of simple laboratory experiments which showed that bleeding pressures known to occur at the bone surface during total hip arthroplasty may compromise the integrity of the bone-cement interface and the cement itself. Such undesirable effects can be prevented by maintaining adequate pressure on the cement until its increased viscosity can resist displacement caused by the bleeding pressure.