Evaluation and Treatment of Patients With Acetabular Osteolysis After Total Hip Arthroplasty

Abstract

As the demand for total hip arthroplasty (THA) continues to increase, the burden of revision THA is also expected to increase. Although the quality of polyethylene has improved markedly, osteolysis continues to be a risk for older designs and younger, active patients. Although progressive but typically asymptomatic in early stages, osteolysis can result in component failure and complicate revision surgery. Serial radiographs are paramount for monitoring progression. Although select cases may be treated with observation, surgery should be considered based on age, activity level, and projected life span. Wellfixed, noncemented modular acetabular components may be treated with curettage and bone grafting, as well as having to bear liner exchange with retention of the acetabular shell. However, in the setting of osteolysis, it is controversial whether bone grafting and component retention is superior to cup revision. This review explores the pathophysiology of osteolysis after THA and provides a comprehensive analysis of the evaluation and treatment of patients with osteolysis.O steolysis after total hip arthroplasty (THA) continues to be a common cause of revision surgery. 1 As such, bearing surface wear has led to contemporary THA prosthesis designs. With the exponential increase in THA procedures being performed and the number of patients with older designs and conventional polyethylene, surgeons must understand implant properties to achieve the most favorable clinical outcomes.

Periprosthetic Osteolysis: Mechanisms, Prevention and Treatment

“…If the prosthesis is stable (well fixed), well aligned, functional, and suitable modular replacement parts can be obtained, then revision surgery is limited to revising the bearing surfaces only and possibly grafting of bone either by bone allografts, or byproducts of bone (such as demineralized bone matrix, iliac crest concentrated cell aspirate), bone-graft substitutes (such as the various osteoconductive or osteoinductive materials), biologics (such as BMP-2, bone morphogenetic protein-2), or combinations thereof [136]. There is controversy regarding whether the outcome for partial revision of modular parts (e.g., polyethylene liner/head exchange only) is better than revision of the entire component (e.g., the polyethylene liner and acetabular metal shell of hip replacements).…”

“…Thus, if outcomes are equal, the simplest route, i.e., liner/head exchange only, is often preferred to revision of the entire component. Once the "wear generator" has been corrected by revision surgery, the osteolytic areas may undergo ossification or stop their progression [136].…”

Impingement of the Sciatic Nerve due to a Protruding Acetabular Cage Rim

“…In this respect, some projections note a growth of revision hip arthroplasty up to 70% by 2030 [4]. Especially in young patients with higher functional demands, the need for cup revisions due to acetabular osteolysis is expected to gain importance [5]. The incidence of sciatic nerve injury after THA is 1.5% [6,7], which increases to 8% in revision THA [7].…”

Aflojamiento aséptico en la prótesis total de cadera

“…3,7,8 FISIOPATOLOGÍA DE LA OSTEÓLISIS EN ATC La que originalmente fue llamada «enfermedad del cemento», ahora se sabe que es un proceso dinámico en el que osteoclastos activados van fagocitando micropartículas debris, el cual puede ser del polimetilmetacrilato, polietileno o partículas metálicas. [7][8][9][10] El estímulo fundamental para la osteólisis es la formación de micropartículas por desgaste en la ATC. El micromovimiento generado en la superficie de carga-soporte de la ATC permite la producción de líquido con alto contenido de partículas.…”

“…El micromovimiento generado en la superficie de carga-soporte de la ATC permite la producción de líquido con alto contenido de partículas. 7,8,10 La generación de partículas en la ATC puede obedecer a dos procesos: desgaste y corrosión. El desgaste ha sido descrito como pérdida de material de la prótesis de revisión es el tratamiento de elección.…”