Of the first 300 consecutive patients who had a Charnley total hip
replacement at the Mayo Clinic during the years 1960 to 1970, 207 (231
hips) were re-evaluated ten years postoperative by questionnaire and
roentgenograms. Forty-three of these were also evaluated by personal
examination. Roentgenographic loosening of the acetabular component was
determined using the criterion of a complete radiolucent line more than one
millimeter in width at the bone-cement interface or any migration or
tilting of the component. For the femoral component, the criterion for
loosening was a radiolucent line more than one millimeter wide at either
the bone-cement or the cement-prosthesis interface, or any change in the
position of the component. As previously reported, the incidence of loose
components at five years was 6.5 per cent for the acetabular component and
24 per cent for the femoral component. At ten years the incidence of
loosening had increased to 11.3 per cent for the acetabular component and
29.9 per cent for the femoral component. Therefore, between five and ten
years postoperatively the rate of femoral loosening decreased, while the
rate of acetabular loosening remained about the same. The overall-revision
rate for loosening of total hip components increased from 3 per cent at
five years to 7.4 per cent at ten years. Acetabular wear was not a
significant problem. Resorption of the medial femoral cortex near the
calcar was generally non-progressive and was not significantly related to
loosening. two modes of loosening are suggested, the more common being
cracking of the cement mantle due to circumferential (hoop) stresses within
the cement. This series probably represents a so-called worst-case
experience, since changes in design and materials as well as the
improvements in surgical technique that have evolved over the past decade
should provide significantly better long-term fixation.