The Journal of Bone and Joint Surgery, Vol 61, Issue 1 28-36, Copyright © 1979 by Journal of Bone and Joint Surgery, Inc
Mechanical failures in total hip replacement requiring reoperation
PM Pellicci, EA Salvati and HJ Robinson
During the years 1971 through mid-1977, approximately 3,000 total hip
replacements were performed at The Hospital for Special Surgery using
metal-to-plastic prostheses. During that period of time, thirty-five
operations were done for mechanical failure in the absence of infection.
The mechanical failures were distributed as follows: Fourteen patients had
dislocations of the prostheses and seven patients had loosening of the
femoral component, mostly with varus positioning of the femoral stem. Six
patients, most of them heavy, active men, had fractures of the femoral
stem. Three patients had loosening of the acetabular component. (In two of
three there was insufficient bone stock over the acetabulum.) Four patients
had proximal migration of the greater trochanter and one had a
fracture-dislocation of the acetabulum. In all cases a technical or
anatomical problem could be identified as the reason for mechanical failure
necessitating reoperation. By careful preoperative planning, proper
selection of procedures and positioning of prostheses, bone-grafting when
necessary, and stricter attention to the technique of using cement, we
could conceivably have avoided two-thirds of these failures.
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