Metallic wear in failed titanium-alloy total hip replacements: A histological and quantitative analysis Journal Article

Authors: Agins, H. J.; Alcock, N. W.; Bansal, M.; Salvati, E. A.; Wilson, P. D. Jr; Pellicci, P. M.; Bullough, P. G.
Article Title: Metallic wear in failed titanium-alloy total hip replacements: A histological and quantitative analysis
Abstract: We conducted extensive histological examination of the tissues that were adjacent to the prosthesis in nine hips that had a failed total arthroplasty. The prostheses were composed of titanium alloy (Ti-6Al-4V) and ultra-high molecular weight polyethylene. The average time that the prosthesis had been in place in the tissue was 33.5 months (range, eleven to fifty-seven months). Seven arthroplasties were revised because of aseptic loosening and two, for infection. In eight hips cement had been used and in one (that had a porous-coated implant for fifty-two months) no cement had been utilized. Intense histiocytic and plasma-cell reaction was noted in the pseudocapsular tissue. There was copious metallic staining of the lining cells. Polyethylene debris and particles of cement with concomitant giant-cell reaction were present in five hips. Atomic absorption spectrophotometry revealed values for titanium of fifty-six to 3700 micrograms per gram of dry tissue (average, 1047 micrograms per gram; normal, zero micrograms per gram), for aluminum of 2.1 to 396 micrograms per gram (average, 115 micrograms per gram; normal, zero micrograms per gram), and for vanadium of 2.9 to 220 micrograms per gram (average, sixty-seven micrograms per gram; normal, 1.2 micrograms per gram). The highest values were found in the hip in which surgical revision was performed at fifty-seven months. The concentrations of the three elements in the soft tissues were similar to those in the metal of the prostheses. The factors to which failure was attributed were: vertical orientation of the acetabular component (five hips), poor cementing technique on the femoral side (three hips), infection (two hipa), and separation of a sintered pad made of pure titanium (one hip). A femoral component that is made of titanium alloy can undergo severe wear of the surface and on the stem, where it is loose, with liberation of potentially toxic local concentrations of metal debris into the surrounding tissues. It may contribute to infection and loosening.
Keywords: clinical article; infection; histology; diagnosis; prosthesis loosening; titanium; prosthesis failure; polyethylene; total hip prosthesis; human
Journal Title: Journal of Bone and Joint Surgery
Volume: 70
Issue: 3
ISSN: 0021-9355
Publisher: Journal of Bone and Joint Surgery  
Date Published: 1988-03-01
Start Page: 347
End Page: 356
Language: English
DOI: 10.2106/00004623-198870030-00005
PUBMED: 3279037
PROVIDER: scopus
Notes: Article -- Source: Scopus
Citation Impact
MSK Authors
  1. Nancy Alcock
    15 Alcock