Prosthetic component failures in hip arthroplasty surgery

• Published in: The Journal of arthroplasty 1995-10, Vol.10 (5), p.575-580
• Main Authors: Heck, David A., Partridge, Cynthia M., Reuben, Jeffrey D., Lanzer, William L., Lewis, Courtland G., Keating, E. Michael
• Format: Article
• Language: English
• Subjects: arthritis; Ceramics; complication; Data Collection; device failure; hip prosthesis; Hip Prosthesis - statistics & numerical data; Humans; Metals; Polyethylenes; Prosthesis Design; Prosthesis Failure; Reoperation
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/S0883-5403(05)80199-8

A survey was conducted of the entire membership of the American Association of Hip and Knee Surgeons to determine their experience with total hip arthroplasty (THA) device-related failures. Forty-seven percent of the membership reviewed their preceding 5-year clinical experience and returned the survey instrument. The aggregate 5-year volume encompassed experience with more than 60,000 hip arthroplastics. The median 5-year experience per respondent was 200 metal-backed sockets and 214 metal stems. The frequency distribution of the number of hip arthrosplatics per respondent was skewed to the right, with fewer surgeons reporting the higher volumes of arthroplasties. In aggregate, 60,115 of the acetabular components used were metal backed. Nonmetal acetabular component usage totaled 3,219. Complete polyethylene failure was defined as fracture or complete wear through of the polyethylene portion of the component. Complete polyethyene failure was seen in 172 metal-backed sockets (29/10,000). Seventy-seven all-polyethylene sockets had complete polyethyelene failure (239/10,000). A total of 87 THAs were revised for modular acetabular dissociations for a dissociation rate of 15/10,000. In aggregate, 64,483 metal-stemmed components were used. Femoral stem fractures occurred in 172 for a rate of 27/10,000. A total of 56,965 metallic femoral components were reported as being modular. Dissociation between the femoral head and neck was uncommonly seen (3/10,000). Use of cereamic femoral heads was low (5,023); however, a total of 11 ceramic head fractures were revised in the 5-year period for a failure rate of 22/10,000. The risks of catastrophic prosthetic THA failure are low but vary according to hip component and the manufacturer of the part. On the basis of this survey, polyethylene is the weakest link in THA prosthetic design. Manufacturers' efforts should continue to address factors leading to polyethylene failure, in addition to the other factors that result in premature prosthetic hip failures. Surgeons and patients may use this information to assist in the selection of quality manufacturers are preferred vendors. Because of the low frequency of device failures, the large simple survey methodology can provide failure rate estimates that cannot be reliably determined by individual orthopaedists or institutions working in isolation.