Treatment of Pelvic Osteolysis Associated with a Stable Acetabular Component Inserted without Cement as Part of a Total Hip Replacement*

Maloney, William J.; Herzwurm, Paul J.; Paprosky, Wayne G.; Rubash, Harry E.; Engh, Charles A.

doi:10.2106/00004623-199711000-00003

Cited by 156 publications

(68 citation statements)

References 7 publications

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“…One study using radiographs to assess healing of bone graft and progression of lesions noted almost 100% incorporation of bone graft material with a major portion of the lesions no longer visible on radiographs [21], and greater than 90% survival at long term followup [32]. In the revised acetabular group, 47% graft fill was surprising since this procedure allows aggressive curetting and reaming of the lesion and complete visualization and probing of the acetabulum.…”

Section: Discussionmentioning

confidence: 99%

“…Bone grafting around and through retained acetabular components along with exchange of the femoral head and acetabular liner has become increasingly popular [3, 20-22, 24, 35, 36]. However, the periacetabular area can be difficult to access when the acetabular shell is well fixed, and osteolytic lesions can be difficult to identify and débride at the time of surgery [10,21,30]. Also, osteolytic lesions may be lined with a pseudomembrane [17,29] that may prevent bone graft incorporation.…”

Section: Introductionmentioning

confidence: 99%

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The Fate of Grafting Acetabular Defects During Revision Total Hip Arthroplasty

Mall

Nunley

Smith

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Acetabular defects are frequently grafted during revision THA. Previous studies using plain radiographs report high rates of graft incorporation. However, given plain radiographs underestimate osteolysis, it is unclear whether plain radiographs adequately reflect graft fill or incorporation. Questions/purposes We determined if (1) graft fill; or (2) incorporation (measured as graft-bone contact) differed with complete revision and grafting compared to liner exchange and grafting; (3) defect fill and incorporation could be assessed on plain radiographs; and (4) the cost of bone grafting differed with these two procedures. Methods We identified 40 patients who underwent revision THA for aseptic loosening or polyethylene wear and osteolysis, either with retention of a well-fixed cup or complete acetabular revision in which bone graft was used. Lesion size, percent fill, and graft healing was quantified from CT scans. A limited cost analysis was performed using the current hospital costs for implants, bone grafts, and bone graft substitutes. The minimum followup was 1 year (mean, 4.8 years; range, 1-11 years). Results The average defect fill was 30% (range, 0%-81%). The average percent of healing to host bone was 24% (range, 0-66%). Complete revisions had a higher percent defect fill compared to head/liner changes (47% versus 17%) as well as a higher degree of graft healing to host bone compared to head/liner changes (36% versus 14%). High resolution CT demonstrated lower percentages of defect fill and graft healing than previous reports based on plain radiographs. Bone grafting costs exceeded implant costs in the head/liner exchange group; however, the overall cost was higher in the complete revision group. Conclusions Higher degrees of defect fill and healing were seen with complete revisions compared to head/liner exchanges. Compared to CT scans, plain radiograph assessment tended to overestimate defect fill and healing. Level of Evidence Level III, therapeutic study. See the guidelines online for a complete description of level of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Fate of Grafting Acetabular Defects During Revision Total Hip Arthroplasty

Mall

Nunley

Smith

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…Osteolysis was defined as the radiographic appearance of any focal area of bone resorption 2 mm wide or greater that was not evident on the radiograph obtained immediately after surgery [27]. We measured the size of the area of osteolysis on the anteroposterior radiograph as the greatest diameter of the lesion in the horizontal and vertical axes [18]. A correction factor for magnification, based on the known diameter and the measured radiographic diameter of the femoral head, was applied to all measured radiographic calculations.…”

Section: Methodsmentioning

confidence: 99%

Femoral Osteolysis Around the Unrevised Stem During Isolated Acetabular Revision

Min

Song

Cho

et al. 2008

Clin Orthop Relat Res

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Many surgeons treat progressive femoral osteolysis in association with a well-fixed stem with bone grafting but in uncontained proximal defects the graft could get into the joint, raising a question regarding whether the osteolysis can be treated by simple débridement without bone grafting. We investigated whether the curetted proximal osteolysis around an unrevised femoral component progressed in size and whether this lesion would have a deleterious effect on fixation of the femoral component in patients with isolated acetabular revision. We prospectively followed 21 patients (24 hips) who underwent acetabular revision and curetting of femoral osteolysis. The minimum followup was 3 years (mean, 4.3 years; range, 3-7

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“…4). 23,28 To deal with a large bone defect in the acetabulum, structural grafting is usually necessary. Total revision of the acetabular component is needed only when the shell is unstable.…”

Section: Preventionmentioning

confidence: 99%

Review Article: Polyethylene Wear and Osteolysis in Total Hip Arthroplasty

Zhu

Chiu

Tang

2001

J Orthop Surg (Hong Kong)

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Polyethylene wear has been accepted as a major cause of osteolysis in total hip arthroplasty. Submicron particles, which are secondary to abrasive wear, migrate into the effective joint space and stimulate a foreign-body response resulting in bone loss which is mainly mediated by macrophages. Diagnosis depends on serial radiographic evaluation and frequent followup. Polyethylene wear and osteolysis can be prevented by reducing the wear such as using a small femoral head, adaptive polyethylene thickness, suitable surgical techniques, non-polyethylene articulation, etc. The presence of cement or circumferential coatings may also retard the distal migration of particles. Medicines such as NSAIDs and bisphosphonate appear to inhibit the progress of osteolysis. As far as treatment, revision surgery is able to reconstruct the joint by replacing partial or total prosthesis and repair the defect by bone grafting according to intraoperative assessment.

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Treatment of Pelvic Osteolysis Associated with a Stable Acetabular Component Inserted without Cement as Part of a Total Hip Replacement*

Cited by 156 publications

References 7 publications

The Fate of Grafting Acetabular Defects During Revision Total Hip Arthroplasty

The Fate of Grafting Acetabular Defects During Revision Total Hip Arthroplasty

Femoral Osteolysis Around the Unrevised Stem During Isolated Acetabular Revision

Review Article: Polyethylene Wear and Osteolysis in Total Hip Arthroplasty

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