Metal debris concentrations in soft tissues adjacent to loosened femoral stems is higher in uncemented than cemented implants

BACKGROUND: There are still many questions related to aseptic femoral stem loosening. Systemic and local immune responses to the implanted “foreign body” is one of the reasons for loosening. The purpose of the study was to measure metal ion concentration (Ti, Co, Cr, Mo, Ni, Al) around loosened femoral stems and compare their levels around uncemented and cemented implants. METHODS: This paper reports 50 hips operated for isolated stem loosening, in 50 patients at the mean age of 57 years (from 21 to 87). There were 25 cemented (Co,Cr(29,)Mo,Ni) and 25 uncemented (Ti, Al) stems. The mean follow-up from primary hip replacement to revision was 10.1 years (from 0.5 to 17). During the procedure, scar tissue around the stem was taken for analysis of metal ions. RESULTS: The concentrations of titanium and aluminium in soft tissues around uncemented loosened stems were higher than cemented ones (p < 0.001, p < 0.001 respectively). However, no statistically significant differences were observed between both types of stems in terms of ions of the metal of which cemented implants had been made of (Co, Cr, Mo, Ni). CONCLUSIONS: In soft tissue around a loosened stem, the concentrations of metal ions from implants are much higher in case of uncemented stems than of cemented ones. Metal ions from vitalium femoral heads were found around uncemented stems in similar values to cemented streams.