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Manage osteolysis of the socket to stop bone loss, prevent loss of fixation

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ORLANDO, Fla. — In 2017, osteolysis remains a concerning complication of total hip replacement on the acetabular side. A presenter at the Current Concepts in Joint Replacement Winter Meeting, here, said joint replacement surgeons must know how to manage osteolysis in patients with cemented or uncemented cups using bone grafting and other techniques.

“Your role is recognition of this particular issue. You need to use plain radiographs, and even perhaps Judet views,” Douglas E. Padgett, MD, said.

Douglas E. Padgett

He said CT, which is easy to interpret, can also be helpful in diagnosing the condition.

“We have had an interest in and an ever-increasing role in the use of [magnetic resonance] MR to establish the same,” he said.

Linear lysis is most common, but extensile osteolysis may be more concerning, Padgett noted.

He described extensile lysis as retroacetabular lysis in bonded, cemented stems with roughened surfaces, which tends to be more aggressive than linear lysis and affect more bone.

“We want to deal with these types of issues: progressive bone loss; potential compromise of fixation; and ultimately, risk of periprosthetic fracture,” Padgett said, adding that managing osteolysis that occurs at the bone/cement interface of a cemented socket involves revision and supplemental grafting.

“I think the data’s clear,” he said.

Today, however, the more common problem is osteolysis of the uncemented socket, Padgett said.

“In the stable implant, it’s lesional treatment if the implant is in good position,” he said.

For stable implants in which there may be a compromised locking mechanism, surgeons should try to perform lesional-type treatment, such as trap-door bone grafting and possibly cementing a new liner into the socket.

“When to revise? When the implant is in poor position. It may be stable, but it’s in suboptimal position, and certainly type 3, where there’s a loose implant,” Padgett said.

“Look for lysis. Be realistic about when to watch and when to graft. Empower the patients,” he said. – by Susan M. Rapp

Reference:

Padgett DE. Paper #64. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 13-16, 2017; Orlando, Florida.

Disclosure: Padgett reports no relevant financial disclosures.