Changes in the bone-cement interface after total hip replacement. An in vivo animal study.

Abstract

In order to study the temporal sequence of radiographic, histological, mechanical, bacteriological, and chemical changes around the femoral component following total hip replacement, a model was created by implanting plastic-on-metal total hip replacements in sheep and walking the animals on a concrete surface beginning six weeks postoperatively. This model demonstrated a decreased torsional rigidity between the prosthesis and the femoral cortex in all sheep. Failure of bonding occurred at the bone-cement interface and appears from our results to be most probably due to alterations in the functional stress of the proximal end of the femur following insertion of the femoral component rather than exothermic polymerization, toxicity of free monomer residue, or infection. An understanding of the causes of loosening of cemented metal femoral components in total hip replacement has been thwarted by a lack of specimens at sequential times in the loosening process. Since a patient is not operated on until the prosthetic components are completely loose, such specimens are difficult to obtain clinically. For this reason a model for examining the bone-cement interface, measured by decreased torsional rigidity of the prosthesis relative to the bone, was developed in sheep. Of all the parameters studied, those inherent in the effects (mechanical or vascular, or both) of insertion of the prosthesis itself appeared to be the most likely cause of the change in the mechanical properties of the interface. This suggests that degenerative changes of the bone-cement interface may be inevitable.