Discriminating the loosening behaviour of cemented hip prostheses using measurements of migration and inducible displacement

Abstract

In vitro pre-clinical tests of hip prostheses have not yet been developed to the extent that inferior prostheses can be ‘screened-out’ prior to animal or clinical trials. This paper reports the experimental part of a project to develop a pre-clinical testing platform for cemented femoral hip implants. It is based on the clinical observation (Kärrholm et al. JBJS, 76B (1994) 912–916) that higher subsidence (distal migration) correlates with early revision of hip prostheses. A protocol to measure the relative movement between implant and bone was designed to test whether or not such a measurement, if made in a laboratory, could discriminate between hip prostheses. The protocol was applied to the Lubinus SPII prosthesis (W. Link, Germany) and a Müller Curved Stem (JRI Ltd., UK)—these prostheses were chosen because they are known to have different loosening rates in vivo. Five prostheses of each design were tested. The migration, the rate-of-migration, and the inducible displacement of each prosthesis was recorded over two million cycles of loading. For each implant, rapid initial migration was found, followed by a period of steady-state migration. In the majority of cases, the prostheses migrated medially, distally and posteriorly. On average, the Lubinus migrated less than the Müller in all directions. The average Lubinus migration was less than half that of the Müller, and this difference was significant at a level of p=0.05. Inducible displacement was greater for the Müller compared to the Lubinus. Furthermore, the inducible displacement decreased over time for the majority of Lubinus prostheses whereas it increased over time for the majority of the Müller prostheses leading to the conclusion that a rapid pre-clinical test based on measurement of inducible displacement may be possible.