The Journal of Bone and Joint Surgery, Vol 70, Issue 3 347-356, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc
Metallic wear in failed titanium-alloy total hip replacements. A histological and quantitative analysis
HJ Agins, NW Alcock, M Bansal, EA Salvati, PD Wilson, PM Pellicci and PG Bullough
Department of Medicine, Memorial-Sloan-Kettering Cancer Center, New York, N.Y. 10021.
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-sic to
3700 micrograms per gram of dry tissue (average, 1047 micrograms per gram;
normal, zero microgram 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 hips), 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.
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