Bone demineralization induced by cementless alumina-coated femoral stems

The biologic compatibility of ceramic materials has been widely demonstrated, and alumina (Al₂O₃) has been used extensively in clinical applications for nearly 20 years. The authors examined the behavior of bone tissue adjacent to the alumina coating in eight cementless hip prosthetic stems that appeared radiologically stable and were explanted because of pain. Histologic evaluation demonstrated the presence of a consistent layer of decalcified bone tissue in continuity with and parallel to the prosthetic interface. Based on laboratory findings, the authors attribute this demineralization phenomenon to a high local concentration of aluminum ions with metabolic bone disease, which is histologically comparable to the osteomalacic osteo-dystrophy described in dialysis patients. These findings must be carefully considered given the potential long-term implications for alumina-coated implants.