Twenty hips in twenty patients had development of femoral endosteal
cortical erosion after a cementless total hip replacement with the
Harris-Galante porous-coated implant. Serial anteroposterior and lateral
radiographs of all of the affected femora were reviewed to determine the
interval between the operation and the first recognition of the osteolytic
lesion or lesions, as well as to evaluate the radiographic appearance and
progression of the lesions. The twenty affected hips were followed for an
average of fifty-three months (range, twenty to seventy-seven months) after
the operation. Osteolysis was first noted radiographically at twelve to
sixty-six months (mean, thirty-nine months) postoperatively; in most
patients, it occurred around the distal portion of the prosthetic stem.
Twelve (60 per cent) of the femoral components were shown to be loose, as
proved either radiographically or operatively. Three of these components
had been judged radiographically to be stable when the endosteal erosion
had first been identified, but they had subsequently migrated. The
remaining eight hips had no evidence of loosening. The osteolysis was more
severe in the femora in which the component was loose than in those in
which it was stable. Of the fourteen patients who were followed, twelve (86
per cent) had an increase in the size of the osteolytic lesions with time,
and only one patient had some radiographic evidence of healing.