Catastrophic failure of an uncemented acetabular component due to high wear and osteolysis: an analysis of 154 omnifit prostheses with mean 6-year follow-up.

BACKGROUND: The purposes of this study were (1) to evaluate the wear pattern of the hydroxyapatite-coated "Dual Radius" Omnifit cup, (2) to investigate whether wear is correlated to any demographic or prosthesis-related factors, and (3) to describe micromotion of both the cup and the stem. PATIENTS AND METHODS: 154 hips were implanted between 1990 and 1996 and followed for an average of 6 years. Wear was measured according to the "Charnley-duo" method and, in 79 hips, with radiostereometry IRSA). RSA was also used to evaluate micromotion. We analyzed the femoral heads using scanning electron microscopy, energy dispersive X-ray spectroscopy and an atomic force microscope. RESULT: 66 cups were revised and had a mean annual wear of 0.32 mm compared to 0.12 mm in hips not revised. Osteolytic processes were observed in 35 hips but at revision osteolysis was present in 51 cases. 43/66 sockets were loose. Micromotion evaluated by RSA, weight, age, side, size of cup, screws, polyethylene thickness or shelf-life of the polyethylene did not correlate to wear, whereas male gender did.
INTERPRETATION: It is still unclear why about half of our cases had an abnormal wear rate. Annual wear exceeding 0.2 mm is prognostic of late failure and should be considered a warning sign.