Abstract
The surface finish of a femoral stem plays an important role in the longevity of cemented total hip arthroplasty. In efforts to decrease the rate of aseptic loosening, some prostheses have been designed to have a roughened surface that enhances bonding between the prosthesis and cement, but clinical outcomes remain controversial. We present a rare case of massive osteolysis with extreme femoral expansion that developed after cemented revision total hip arthroplasty. The destructive changes in the femur were attributable to abnormal motion of the stem and were aggravated by the roughened precoated surface of the long femoral component. Revision surgery using a total femur prosthesis was performed because there was insufficient remaining bone to fix the new prosthesis. The surgical technique involved wrapping polypropylene meshes around the prosthesis to create an insertion for the soft tissue, which proved useful for preventing muscular weakness and subsequent dislocation of the hip.
Highlights
Aseptic loosening is the most common cause of total hip arthroplasty failure and is generally caused by wear debris from the polyethylene cup
Only one similar case has been reported by Kalhor et al In their case, massive femoral shaft osteolysis was associated with a Wagner cementless long stem, and they suggested that poor initial fit of the stem, stem motion, and fluid pressure induced a pendulum type of stem motion [12]
The Harris precoat-plus prosthesis used in our patient has a roughened or textured surface with a proximal methylmethacrylate precoating that is designed to prevent aseptic loosening by improving the bond between the femoral component and cement
Summary
Aseptic loosening is the most common cause of total hip arthroplasty failure and is generally caused by wear debris from the polyethylene cup. In the 1980s, roughened, textured, or precoated femoral stems were produced to reduce the rate of aseptic loosening by enhancing the bonding between the stem and cement and good clinical outcomes were reported [4, 5]. Early catastrophic failures were reported as a result of cement fractures and debonding of the stem, followed by particle generation due to cement abrasion because of the roughened surface of the stem, resulting in femoral osteolysis [3, 6,7,8,9,10,11]. We report here a rare case of massive femoral osteolysis around a cemented roughened long stem
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