The Role of Cement in the Long Term Performance and Premature Failure of Charnley Low Friction Arthroplasties

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Abstract
A number of polyethylene acetabular cups (59) and femoral stems (38) of Charnley hip prostheses were obtained following revision surgery and examined by scanning electron microscopy. In many cases, acrylic cement particles were embedded in the articulating surface of the cups. These particles caused surface pitting. The appearance of the articulating surfaces suggested that some cement had been present from the time of arthroplasty. In other cups there was evidence of cement ingress during the service life. Failure to use sufficient cement at arthroplasty resulted in cavities on the backs of the cups. Many femoral heads had become scratched in vivo, the surface roughness increasing from an initial value less than 0.02 μm Ra to a value on removal of 0.07 μm Ra. The increased roughness increases the amount of wear in the polyethylene sockets. Laboratory tests show that retrieved acrylic cement particles will scratch stainless steel, and it is our conclusion that entrapped cement will damage both components of the prosthesis and may cause premature failure.