Cementation and Interface Analysis by Different Microscopically Techniques of Failure Cases After BHR Arthroplasty

Birmingham hip resurfacing (BHR) is an alternative to bone-sparing total hip arthroplasty; however, failures may be associated with the cementing technique. This study aimed to evaluate the characteristics of the cement layer and potential failure mechanisms. BHR explants were analyzed using radiographic evaluation, stereomicroscopy, scanning electron microscopy (SEM), and histopathology. 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 may be associated with a complex interplay between cementation parameters, cement mantle morphology, and the biological response at the bone–cement interface, as well as interactions at the cement–prosthesis interface. Microscopic evaluation may provide valuable insights into the mechanisms potentially contributing to BHR prosthesis failure.