Whole-mount specimens in the analysis of en bloc samples obtained from revisions of resurfacing hip implants: A report of 4 early failures

BACKGROUND: Modern metal-on-metal hip resurfacing implants are being increasingly used for young and active patients, although the long-term outcome and failure mechanisms of these implants are still unknown. In this consecutive revision case series, early failures of femoral implants (at < 4 years) were studied. METHODS: 3 revisions were done due to a fracture of the femoral neck and 1 due to loosening and varus position of the femoral component. Femoral heads were removed en bloc 2–46 months after the primary operation, embedded in methylmethacrylate, sectioned, stained, and analyzed as whole-mount specimens in 4 55–62-year-old patients with osteoarthritis. RESULTS: Histopathology was characterized by new but also partly healed trabecular microfractures, bone demineralization, cysts, metallosis, and abnormal formation of new woven bone. All samples displayed signs of notching, osteoporosis, and aseptic necrosis, which seemed to have been the main reason for the subsequent development and symptoms of the patients and revision operations of the hips. INTERPRETATION: Based on these early revision cases, it appears that aseptic necrosis is a common cause of early loosening of resurfacing hip implants.