Osteolysis in cemented total hip arthroplasty involving the OptiPlug cement restrictor: more than an incident?

Hanssen, Nicole M.A.I.; Schotanus, Martijn G.M.; Verbürg, A.D.

doi:10.1007/s00590-013-1366-z

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…2011 , Hanssen et al. 2015 ). There is no explanation as to why some patients develop a higher degree of osteolysis than others, and the timeline until the osteolytic process is complete is not predictable.…”

Section: Discussionmentioning

confidence: 99%

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Osteolytic changes around biodegradable cement restrictors in hip surgery

et al. 2016

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Background and purposeBiodegradable cement restrictors are widely used in hip arthroplasty. Like others, we observed osteolytic reactions associated with a specific cement restrictor (SynPlug; made of PolyActive) and reviewed our patients.Patients and methodsWe identified 703 patients with suitable radiographs from our database (2007 to 2012) who underwent cemented hip arthroplasty and received a SynPlug biodegradable cement restrictor. We reviewed all available radiographs to determine the incidence, severity, and progression of osteolysis. Mean postoperative follow-up was 1.8 (1–7) yearsResults1 year after implantation, the femoral cortex showed thinning by 12% in the anterior-posterior view and by 8% in the axial view. This had increased to 14% and 12%, respectively, at the latest available follow-up postoperatively (at a mean of 4 years). Cortical thinning of less than 10% was found in 37% of patients, but cortical thinning of 10–30% was found in 56% of patients. In the remaining 7%, a reduction of more than 30% of the original cortical thickness was observed.InterpretationOsteolytic changes associated with the SynPlug biodegradable bone restrictors are inconsistent and highly variable. While some patients showed increased weakening of the femoral cortex with the potential risk of periprosthetic fracture, in others the degree of osteolysis only increased slightly or stabilized after 2 or more years. Any cortical bone loss after total hip replacement should be avoided, so the use of PolyActive biodegradable cement restrictors should be discontinued. Patients with a PolyActive cement restrictor in place should be followed up closely after surgery.

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Section: Discussionmentioning

confidence: 99%

“… 2012 , Hanssen et al. 2015 )—has also been observed. 1 case report identified a fracture due to restrictor-induced osteolysis (Dhawan et al.…”

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confidence: 87%

Osteolytic changes around biodegradable cement restrictors in hip surgery

et al. 2016

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“…8,9 Recent reports reveal progressive osteolysis surrounding biodegradable cement restrictors, especially restrictors with polyethylene glycol/polybutylene terephthalate (PEG/PBT) copolymer as a compound. [10][11][12] 1 case report presented a periprosthetic fracture due to excessive osteolysis surrounding the cement restrictor. 13 We are not aware of any register that records the cement restrictor as a separate component of a cemented THA, the follow-up on the cement restrictor may have been neglected.…”

Section: Introductionmentioning

confidence: 99%

Comparison of osteolysis around 3 different cement restrictors in total hip arthroplasty

Prins,

Cornelissen,

Goudriaan

et al. 2024

HIP International

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Background and aim: Several studies reported osteolysis around polyethylene glycol/polybutylene terephthalate (PEG/PBT) based femoral cement restrictors. Our goal was to evaluate and compare osteolysis around 3 different plug designs: the slow biodegradable PEG/PBT cement restrictor; the fast biodegradable gelatin cement restrictor; and the non-biodegradable polyethylene plug. Patients and methods: In a retrospective multicentre cohort study chart data were extracted of patients who received a total hip arthroplasty between 2008 and 2012. A total of 961 hips were included. Cortical ratio between inner and outer cortices at the centre of the plug was measured on routine postoperative follow-up moments. Median follow up of all 3 hospitals was 3.5 years (1.4–7.3). The primary outcome was evidence of osteolysis (i.e. the difference in cortical ratio [CR]) on anteroposterior (AP) radiographs at final follow-up. Results: Progressive osteolysis was found around the PEG/PBT cement restrictor represented by a significantly increasing cortical ratio (ΔCR 0.067 (95% CI, 0.063–0.071). Distance from tip prosthesis to plug and size of the plug were found to be independent factors in predicting increased cortical ratio. Conclusions: Our multicentre cohort shows increase of cortical ratio around the PEG/PBT cement restrictor which progresses over time. Physicians should be aware of this fact and are advised to intensify follow-up of patients who received this cement restrictor.

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Osteolytic change surrounding biodegradable cement restrictors used in total hip replacements mimicking malignancy

Ariyaratne,

Davies,

Evans

et al. 2024

IJMSR

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Peri-prosthetic osteolysis is a well-documented complication of total hip arthroplasty. A lesser-known form of peri-prosthetic osteolysis occurs specifically involving biodegradable cement restrictor devices which may be used in total hip replacements (THRs) to contain the cement material within the femoral medullary canal, which would help maintain adequate pressurization within the canal and secure the prosthetic femoral stem. The device is inserted into the femoral medullary canal just distal to the prosthetic stem. Different types of restrictors are used; certain biodegradables forms of restrictors are known to cause progressive osteolysis at the site of insertion, which can present as a gradually enlarging focal lytic lesion on imaging. While this entity as well as its relevance as a risk factor for peri-prosthetic fracture has been discussed in existing literature, the resemblance of this entity to a neoplastic process, particularly given the gradual enlargement over time is not well-documented. Understanding this process and potential pitfall when interpreting imaging, particularly X-rays, in patients who have previously undergone a THR, is important to avoid misdiagnosis of this otherwise benign entity as a neoplastic process and would potentially negate the need for unnecessary investigations.

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Osteolysis in cemented total hip arthroplasty involving the OptiPlug cement restrictor: more than an incident?

Cited by 3 publications

References 21 publications

Osteolytic changes around biodegradable cement restrictors in hip surgery

Osteolytic changes around biodegradable cement restrictors in hip surgery

Comparison of osteolysis around 3 different cement restrictors in total hip arthroplasty

Osteolytic change surrounding biodegradable cement restrictors used in total hip replacements mimicking malignancy

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