In order to study the temporal sequence of radiographic, histological,
mechanical, bacteriological, and chemical changes around the femoral
component following total hip replacement, a model was created by
implanting plastic-on-metal total hip replacements in sheep and walking the
animals on a concrete surface beginning six weeks postoperatively. This
model demonstrated a decreased torsional rigidity between the prosthesis
and the femoral cortex in all sheep. Failure of bonding occurred at the
bone-cement interface and appears from our results to be most probably due
to alterations in the functional stress of the proximal end of the femur
following insertion of the femoral component rather than exothermic
polymerization, toxicity of free monomer residue, or infection. Clinical
Relevance: An understanding of the causes of loosening of cemented metal
femoral components in total hip replacement has been thwarted by a lack of
specimens at sequential times in the loosening process. Since a patient is
not operated on until the prosthetic components are completely loose, such
specimens are difficult to obtain clinically. For this reason a model for
examining the bone-cement interface, measured by decreased torsional
rigidity of the prosthesis relative to the bone, was developed in sheep. Of
all the parameters studied, those inherent in the effects (mechanical or
vascular, or both) of insertion of the prosthesis itself appeared to be the
most likely cause of the change in the mechanical properties of the
interface. This suggests that degenerative changes of the bone-cement
interface may be inevitable.