Revision Total Hip Arthroplasty for Pelvic Osteolysis With Well-Fixed Cementless Cup

Chang, Jun-Dong; Yoo, Je-Hyun; Hur, Mina; Lee, Sang-Soo; Chung, Yung-Khee; Lee, Chang-Ju

doi:10.1016/j.arth.2007.05.049

Cited by 16 publications

(14 citation statements)

References 19 publications

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“…Some surgeons have advocated delayed intervention, observing the patients are typically asymptomatic, surgical treatment can lead to complications, and the incidence of late loosening or pelvic fracture associated with osteolysis appears to be low [2,4,6,9,11,14,15]. Others have recommended surgery with the goal of arresting the bone loss and avoiding cup loosening [5,16,27,30,34]. Current surgical options include polyethylene liner exchange or complete cup revision, both of which can be performed with or without débridement and bone grafting of the osteolytic defects [1,13,23,26,35].…”

Section: Introductionmentioning

confidence: 99%

A Three-dimensional Method for Evaluating Changes in Acetabular Osteolytic Lesions in Response to Treatment

Egawa

Huynh

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Section: Introductionmentioning

confidence: 99%

A Three-dimensional Method for Evaluating Changes in Acetabular Osteolytic Lesions in Response to Treatment

Egawa

Huynh

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…However, in the setting of a well-positioned and osseointegrated cup, the optimal approach has not been conclusively established. Some authors recommend preserving cups and grafting defects if the cups are modular and well fixed, have an intact-locking mechanism and are in an acceptable position and if an appropriate PE liner is available [6][7][8][9][10]26]. Other authors recommend removing even well-fixed cups at revision, noting that this will enhance identification of the extent of OS and facilitate grafting of defects [1,5,27,28].…”

Section: Discussionmentioning

confidence: 99%

“…In this procedure, the granuloma of the osteolytic lesion is débrided, morsellised bone is inserted into the osteolytic defect and the PE liner and femoral head are replaced. If the cementless cup is modular and well fixed, has an intact locking mechanism, is in an acceptable position and if an appropriate PE liner is available, the cup should be preserved [6,8,14,26,30]. In our experience, the key to successful surgery that will retain a well-fixed cup is careful preoperative planning, which includes a detailed medical history and conducting a thorough physical examination to determine the previous surgical approach employed and the components inserted and to rule out infection.…”

Section: Discussionmentioning

confidence: 99%

“…This presents the surgeon with the difficult decision of whether to revise a well-fixed acetabular component. The solution to this dilemma is controversial: Some authors advocate acetabular component removal [1,5], whereas others believe that a stable acetabular component should be left in place [6][7][8][9][10]. Good results have been reported for retention of a well-fixed cup plus bone grafting, including allograft bone and demineralised bone matrix (DBM), with intraoperative confirmation of cup stability [9,[11][12][13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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Retention of a well-fixed acetabular component in the setting of acetabular osteolysis

Kang

Yang

Zhou

et al. 2012

International Orthopaedics (SICOT)

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Purpose The treatment strategy for pelvic osteolysis with a well-fixed acetabular component after total hip arthroplasty (THA) involves replacing the acetabular cup liner and femoral head, débriding osteolytic lesions, and grafting. Methods We investigated whether retention of a well-fixed acetabular component using the two-approach techniquethe ilioinguinal approach combined with the posterolateral approach-was compatible with socket survival. We reviewed clinical and radiographic findings for 24 patients (24 hips) who had undergone acetabular revision arthroplasty of a well-fixed socket for progressive osteolysis. The surgical techniques used included osteolytic lesion débride-ment and bone grafting through the ilioinguinal approach, and replacement of the acetabular liner and femoral head through the posterolateral approach. Results The mean duration of follow-up after revision was 2.3 (range 2.1-3.9) years. At follow-up evaluation, all acetabular components were well fixed and showed no evidence of loosening, osseous integration was apparent and there was no radiographic evidence that any lesions had progressed. No new osteolytic lesions were identified, and there were no clinical or radiographic complications. Conclusions Curettage and bone grafting under direct vision, cup liner and femoral-head replacement because of progressive retroacetabular osteolysis and retention of wellfixed components using the two-approach technique results in good osseous integration of lysis. Larger studies with longer follow-up periods are required to establish the longterm success of this technique.

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“…D'altro canto, Chang e coll. hanno rivisto 62 revisioni convenzionali di componenti acetabolari e riportato risultati molto soddisfacenti, senza complicazioni severe [23]. Tant'è che raccomandano la revisione cotiloidea specialmente nel paziente giovane, per il quale l'intervento dovrebbe essere particolarmente efficace.…”

Section: Introduzioneunclassified

Osteolisi retroacetabolari senza usura dell’inserto: trattamento chirurgico conservativo

d’Imporzano

Fischer

Pierannunzii

2009

LO SCAL

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IntroduzioneLe lesioni osteolitiche sono reperti radiografici comuni nell'osso retrostante a coppe acetabolari in protesi totali dell'anca (PTA). La frequenza con la quale vengono scoperte è collegata alla sensibilità della tecnica di "imaging". Stulberg e coll.[1] hanno dimostrato come la valutazione delle protesi d'anca con TAC evidenzi una frequenza di osteolisi ben superiore a quella rilevata con tecniche radiologiche convenzionali. Secondo il modello fisiopatologico più accreditato, le osteolisi periprotesiche sono da considerarsi una risposta infiammatoria cronica ai detriti [2-6]. Nonostante sia spesso il polietilene a essere associato a questa reazione granulomatosa, anche il "debris" di ceramica o metallo può essere implicato [7-9]. Il diametro delle particelle ha un ruolo fondamentale nel condizionare gli effetti della fagocitosi [10,11]. Le particelle più grandi (>1 µm) sono più facilmente destinate a essere rivestite da cellule giganti, in modo tale che il corpo estraneo sia virtualmente rimosso dall'ambiente biologico, mentre particelle submicrometriche possono essere fagocitate da macrofagi e indurne l'attivazione. Le cellule attivate rilasciano alcune citochine proinfiammatorie come IL-1 e TNF-α, il cui effetto sull'osteoclastogenesi e sull'attività osteoclastica è ben noto. Questo effetto è probabilmente mediato da osteoblasti residenziali e cellule stromali, che producono RANKL ("receptor activator of the NFkB ligand") come risposta alla stimolazione con citochine. L'interazione tra RANKL e il suo recettore RANK sulla superficie dei precursori emopoietici induce la differenziazione in senso osteoclastico, mentre sulla superficie degli osteoclasti maturi induce l'attivazione degli stessi [12,13]. In più, macrofagi attivati possono intervenire direttamente nel riassorbimento producendo una metalloproteasi, che digerisce la matrice extracellulare. La via RANK-RANKL viene inibita da un agonista solubile di RANKL, l'osteoprotegerina (OPG), che viene espresso della stessa populazione cellulare (osteoblasti e cellule stromali) rispondendo a stimoli diversi (estradiolo, TGF-β‚1, BMP-2, ecc.) [14]. Lo squilibrio tra concentrazioni locali di RANKL e OPG sembra essere un fattore chiave nel ri- ABSTRACT -BEARINGS RETAINING TREATMENT OF RETROACETABULAR OSTEOLYTICBearings retaining treatment of retroacetabular osteolytic lesions is a salvage procedure for metal -polyethylene or ceramic -polyethylene total hip replacements that do not show liner wear. The present report shows midterm results of this original technique from an ongoing pilot study. The successful outcome induces us to prolong our follow-up and extend the case series. Only long-term observation will evaluate the effectiveness as for the implant salvation.

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Revision Total Hip Arthroplasty for Pelvic Osteolysis With Well-Fixed Cementless Cup

Cited by 16 publications

References 19 publications

A Three-dimensional Method for Evaluating Changes in Acetabular Osteolytic Lesions in Response to Treatment

A Three-dimensional Method for Evaluating Changes in Acetabular Osteolytic Lesions in Response to Treatment

Retention of a well-fixed acetabular component in the setting of acetabular osteolysis

Osteolisi retroacetabolari senza usura dell’inserto: trattamento chirurgico conservativo

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