Management of Wear and Osteolysis

Chapter Synopsis

Periprosthetic osteolysis remains a common cause of late failure after total hip arthroplasty (THA). This failure mechanism is particularly important for younger, active patients, who will undoubtedly challenge the durability of modern bearing surfaces in the future. Good midterm results with retention of the implants have been achieved in certain cases. Cases that do not meet the strict criteria for implant retention outlined in this chapter should be treated with full revision of the implants.

Important Points

• Treatment is indicated for patients with osseointegrated, cementless sockets when osteolytic lesions of the pelvis progress over a 3- to 6-month period.

• Severe polyethylene wear may justify a lower threshold for treatment, because it is better to intervene before the head wears through the liner and engages the shell.

Clinical/Surgical Pearls

• Factors that determine whether the well-fixed shell can be retained include the ability to exchange the liner, extent of osseointegration, position of the socket, and the type of fixation surface (i.e., three-dimensional ingrowth versus two-dimensional ongrowth pattern).

• In cases of femoral osteolysis, operative treatment is indicated for progressive lesions, diaphyseal osteolysis, impending fracture, and pain.

• Factors that determine whether the osseointegrated femoral component can be retained include location of the lesion, exchangeability of the femoral head, and extent of osseointegration.

Clinical/Surgical Pitfalls

• Although implant retention and grafting is appropriate in certain cases, surgeons must be prepared to revise the implants if the strict criteria outlined in this chapter are not met.