Cementation and interface analysis by different microscopically techniques of failure cases after BHR hip-resurfacing arthroplasty

Razvan Adam 1,2, Iulian Antoniac 3,4*, Adam Stuparu Andreea Minodora 2, Iuliana Corneschi 3, Larisa Popescu 3, Alexandru Stere 3, Sergiu Focsaneanu 3, Florin Miculescu 3 and Ioana Dana Carstoc 5

1 Orthopedic Department, Clinical University Emergency Hospital Elias, 17 Maraști Blvd., 011461 Bucharest, Romania; adamrazvan@yahoo.com (A.R.)

2 Faculty of General Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 38 Gh. Marinescu Street, 540142 Targu Mures, Romania; adamrazvan31@gmail.com (A.S.A.M.)

antoniac.iulian@gmail.comiuliana.corneschi@stud.sim.upb.romaria.popescu2010@stud.sim.upb.roa.stere@ortovit.eufocsaneanu.sergiu@gmail.comflorin.miculescu@upb.ro

3 Faculty of Materials Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul IndependenteiStreet, 060042 Bucharest, Romania; antoniac.iulian@gmail.com (I.A.); iuliana.corneschi@stud.sim.upb.ro (I.C.); maria.popescu2010@stud.sim.upb.ro (L.P.); a.stere@ortovit.eu (A.S.); focsaneanu.sergiu@gmail.com (S.F.); florin.miculescu@upb.ro (F.M.)

4 Academy of Romanian Scientists, 54 Splaiul Independentei Street, 050094 Bucharest, Romania

5​Faculty of Medicine, University Lucian Blaga of Sibiu, 2A Lucian Blaga Street, 550169 Sibiu, Romania; ioana.carstoc12@gmail.com (I.D.C.)

Introduction 

Birmingham Hip Resurfacing (BHR) is an alternative to bone-sparing total hip arthroplasty; however, failures remain associated with the cementing technique. This study aimed to evaluate the characteristics of the cement layer and failure mechanisms related to the interface using microscopic analysis..

Keywords: Birmingham Hip Resurfacing; cement; failure; microscopic analysis

Experimental. 

BHR explants were analysed using radiographic evaluation, stereomicroscopy, scanning electron microscopy (SEM), and histopathology

Results and Discussion. 

The cement layer was nonuniform, with excessive thickness in the dome regions and insufficient lateral coverage. Increased cement penetration values ​​exceeded recommended thresholds. SEM analysis revealed inhomogeneous cement with cracks, air inclusions, and loosening at the cement-prosthesis interface. BHR failure appears to result from a complex interplay between cementing parameters, layer morphology, and biological response at the bone-cement interface, as well as cement-prosthesis interaction. Microscopic evaluation provided important information about BHR prosthesis failure

Conclusions. 

The results support the hypothesis that the failure of BHR hip resurfacing prostheses is influenced primarily by technical errors in cementation and by the patient's biomechanical peculiarities. Optimization of surgical techniques and rigorous case selection remain essential to increasing the durability of BHR hip prostheses

References. (Times New Roman font, size 11)

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