Inflammatory tissue reactions around aseptically loose cemented hip prostheses: A retrieval study of the Spectron EF stem with Reflection All-Poly acetabular cup

Susann Wolf, Anne Christine Johannessen, Peter Ellison, Ove Furnes, Geir Hallan, Katharina Rogg, Kathrine Skarstein, Paul Johan Høl

Research output: Contribution to journalArticlepeer-review


The cemented Spectron EF stem in combination with the cemented non-crosslinked Reflection All-Poly cup showed a high rate of mid-term aseptic loosening. However, the failure mechanisms are not fully known. We assessed the inflammatory tissue reactions and wear particles in periprosthetic tissues, implant wear and blood metal ion levels in 28 patients with failed implants. Histological analysis showed a macrophage pre-dominant pattern with randomly distributed lymphocytes, with various amounts of neutrophils and giant cells. The number of different cell types in the tissue samples from patients in the cup group and in the stem group was similar. Wear particles, mainly ZrO 2 , CoCrMo, and polyethylene particles of different sizes and shapes, were associated with macrophages/giant cells, and total particle load/mm 2 was higher in cases of stem loosening. The Spectron EF stems were heavily worn, abraded, and polished. Stem abrasion correlated with metal ion concentrations in blood. The median polyethylene wear rate of the Reflection cups was 0.23 mm/year. The high proximal roughness of the Spectron EF stem resulted in excessive cement wear during loosening. The resulting inflammatory tissue responses to the degradation products both from the cup and the stem led to massive osteolysis and subsequent implant loosening.

Original languageEnglish
Pages (from-to)1624-1636
Number of pages13
JournalJournal of biomedical materials research. Part B, Applied biomaterials
Issue number7
Early online date31 Jan 2022
Publication statusPublished - Jul 2022

Bibliographical note

© 2022 The Authors. Journal of Biomedical Materials Research Part B: Applied Biomaterials published by Wiley Periodicals LLC.


  • Acetabulum
  • Arthroplasty, Replacement, Hip/adverse effects
  • Hip Prosthesis/adverse effects
  • Humans
  • Inflammation
  • Metals
  • Polyethylene
  • Prosthesis Design
  • Prosthesis Failure

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