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The Journal of Bone and Joint Surgery, Vol 74, Issue 8 1119-1129, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Early and late loosening of the acetabular cup after low-friction arthroplasty
E Garcia-Cimbrelo and L Munuera
Department of Orthopaedics, Hospital La Paz, Universidad Autonoma de Madrid, Spain.
Between 1971 and 1979, 680 low-friction arthroplasties of the hip were
performed in 598 patients. The average duration of follow-up was twelve
years and eight months. Sixty-one acetabular cups had loosening as seen on
roentgenograms eighteen years postoperatively, resulting in a total
cumulative probability of loosening of 19 per cent, according to
survivorship analysis. In twenty-nine cups, the loosening appeared within
ten years after the operation (early loosening) and in thirty-two, more
than ten years after the operation (late loosening). Early loosening was
associated with deficient structure of the bone of the acetabulum, a
previous congenital dislocation of the hip, acetabular fracture, or
acetabular protrusion in all instances (p < 0.01). Late loosening was
associated with the depth of acetabular wear. Of the thirty-two cups that
had more than two millimeters of wear, eighteen (56 per cent) had loosening
on the roentgenograms (p < 0.001). In hips that had early loosening,
migration was the most frequent finding, and its rate of progression was
higher than in hips that had late loosening (p < 0.001). In late
loosening, a complete bone-cement radiolucency of more than two millimeters
was the most frequent finding. Clinical failure was seen in twenty-two (76
per cent) of the twenty-nine cups that loosened early and in nine (28 per
cent) of the thirty-two cups that loosened late. The probability of
extensive resorption of bone necessitates close observation of patients who
have early loosening, while a reasonable period of observation is possible
for those who have late loosening.
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