The Journal of Bone and Joint Surgery 82:1102 (2000)
© 2000 The Journal of Bone and Joint Surgery, Inc.
Characterization of Long-Term Femoral-Head-Penetration Rates
Association with and Prediction of Osteolysis*
James E. Dowd, M.D. ,
Christi J. Sychterz, M.S. ,
Anthony M. Young, B.S. and
Charles A. Engh, M.D.
Investigation performed at the Anderson Orthopaedic Research
Institute, Alexandria, Virginia
*One or more of the authors has received or will receive benefits
for personal or professional use from a commercial party related
directly or indirectly to the subject of this article. No funds
were received in support of this study.
Orthopaedic Associates of Virginia, 6275 East Virginia Beach
Boulevard, Suite 300, Norfolk, Virginia 23502.
Anderson Orthopaedic Research Institute, P.O. Box 7088, Alexandria,
Virginia 22307.
Background: We examined the relationship
between long-term femoral-head-penetration patterns and osteolysis in
a ten-year follow-up study of a well controlled patient population.
The purposes of this study were to characterize the linearity of
long-term head-penetration patterns over time, to describe the relationship
between ten-year true wear rates and osteolysis, and to determine
whether the occurrence of osteolysis at ten years could be predicted
by penetration data obtained prior to five years.
Methods: Temporal femoral-head-penetration patterns
were examined at a minimum of ten years after forty-eight primary
total hip arthroplasties. The arthroplasties were performed with
the use of an Arthropor acetabular cup (Joint Medical Products)
and a thirty-two-millimeter-diameter cobalt-chromium femoral head
(DePuy). Using a computer-assisted radiographic technique, we evaluated
two-dimensional head penetration on serial annual radiographs. Linear
regression analysis modeled penetration-versus-time data as a line
for each patient. The slope of the regression line indicated the true
wear rate for each patient. In a subgroup of thirty-four hips for
which three annual radiographs had been made less than five years
after the arthroplasty, we compared early head-penetration patterns
with the later occurrence of osteolysis.
Results: For all forty-eight hips, the true
wear rate averaged 0.18 millimeter per year (range, 0.01 to 0.44 millimeter
per year) and temporal head-penetration patterns tended to be linear
(mean r2 = 0.91 ± 0.16).
Osteolysis at ten years was strongly associated with increasing
true wear rates (p < 0.001). Osteolysis did not develop in any
of the nine hips with a true wear rate of less than 0.1 millimeter
per year. However, osteolysis developed in nine (43 percent) of
twenty-one hips with a rate between 0.1 and less than 0.2 millimeter
per year, in eight of ten hips with a rate between 0.2 and 0.3 millimeter
per year, and in all eight hips with a rate of greater than 0.3
millimeter per year. Evaluation of early true wear rates as a predictor
of late osteolysis showed a similar relationship.
Conclusions: This study demonstrates that true
wear rates tend to be constant and that increased true wear is significantly
associated with osteolysis at ten years after the operation. A similar
relationship was also found at the early follow-up interval, indicating that
early true wear rates (determined from serial radiographs) might
enable orthopaedists to predict if patients are at risk for the
development of osteolysis.
Clinical Relevance: On the basis of these findings,
we use temporal femoral-head-penetration data in our practice to evaluate
polyethylene inserts in asymptomatic patients, to estimate the time
to component wear-through, and to adjust the frequency of follow-up evaluations
for monitoring the development of osteolytic lesions in at-risk
patients.
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