Total hip arthroplasty with Boneloc cement: Unsatisfactory results in 163 hips after 9 to 11 years

Abstract

Boneloc bone cement was introduced in the Netherlands in 1992. Inferior short-term results were reported which led to the withdrawal of Boneloc from clinical use in 1995. However, little is known about the long-term outcome of hip arthroplasties with Boneloc. Between April 1992 and August 1994, Boneloc was used in 163 Mallory-Head primary total hip arthroplasties in 163 patients. Follow-up analysis was performed in 2003. To date, 27 hips (17%) have been revised for aseptic loosening of the femoral component. Median time to revision was 5.5 years. Survival analysis based on revision for aseptic loosening showed 77% cumulative survival at 11 years. With revision for aseptic loosening and/or definite radiological loosening according to Harris as endpoint, cumulative survival was 59% at 11 years. In 27 of 43 patients with definite radiological loosening, a cement fracture was seen at a median of 2.9 years. These results show failure of Boneloc cemented total hip arthroplasties occurring even during the later follow-up. Continuing periodic clinical and radiological examination is recommended.

Implant Fixation and Risk of Prosthetic Joint Infection Following Primary Total Hip Replacement: Meta-Analysis of Observational Cohort and Randomised Intervention Studies

“…A number of mechanisms may account for some of the associations demonstrated. The increased risk of overall PJI associated with cemented prostheses compared with uncemented prostheses has been attributed to bone necrosis caused by direct toxicity or generation of heat during the polymerization process [45], which may create conditions conducive for bacterial growth [46]. Another potential explanation is the longer duration of surgery for cemented THRs (compared with uncemented THRs), hence an increased likelihood of perioperative contamination [27].…”

Does cement increase the risk of infection in primary total hip arthroplasty? Revision rates in 56,275 cemented and uncemented primary THAs followed for 0–16 years in the Norwegian Arthroplasty Register

“…Cement per se may create conditions for growth of the omnipresent bacteria, for example by causing bone necrosis, by toxicity or by generation of heat during polymerization (Mjöberg 1997, Jonbergen et al 2004). However, some authors doubt that the curing process of the cement causes thermal injury (Toksvig-Larsen et al 1991).…”

Influence of Fixation Methods on Prosthetic Joint Infection Following Primary Total Knee Replacement: Meta-Analysis of Observational Cohort and Randomised Intervention Studies

“…Compared to uncemented prostheses, cemented prostheses may cause an increased risk of infection via a number of pathways. Evidence from studies conducted in THR patients suggest the bone necrosis caused by direct toxicity or generation of heat during the cemented polymerization process [38] may create conditions conducive for bacterial growth [39,40]; although in TKR, it is unlikely that the cement mantle thickness reaches the threshold required to lead to osteonecrosis. Compared to uncemented TKR, cemented TKR has a longer operating room time [41], which may increase the likelihood of perioperative contamination [42].…”