Osteolysis

SAN FRANCISCO — Results presented here showed use of telehealth may improve in-office efficiency and evaluation, and improve access to health care among patients with symptomatic total joint arthroplasty.

WAIKOLOA, Hawaii — Late osteolysis may still be a concern for patients undergoing total hip arthroplasty with highly crosslinked polyethylene, despite notable reductions in wear and improved survivorship, a speaker said.

Anatomic total shoulder arthroplasty with a partially cemented polyethylene glenoid component, or anchor peg implant, may yield “in between fin” bone growth and decreased pain, according to recently presented results.

After anatomic shoulder arthroplasty with the same glenoid component, patients who received stemless ceramic-head implants had fewer radiolucent lines and less osteolysis than patients who received long-stem metal-head humeral implants.

Total knee arthroplasty implants with porous and hydroxyapatite coatings and fixation pegs had similar clinical outcomes and survivorship rates compared with knee implants with a porous coating only, according to published results.

The algorithm for revision surgery for after metal-on-metal THA has evolved, and symptomatic patients are encouraged to consider revision. However, for asymptomatic patients with adverse local tissue reaction (ALTR; 31% in one study), shared decision-making between the surgeon and patient is important. In these cases, patients should be counseled about the risks and benefits of revision THA. The magnitude of revision depends on the prosthesis (modular or monoblock) and the extent of soft tissue and implant damage. If the THA is modular, we recommend liner exchange with highly crosslinked polyethylene and placement of a large ceramic head with titanium sleeve, removing all cobalt chrome alloy components. Cup revision is recommended if the primary THA prosthesis is monoblock or with extensive acetabular osteolysis, and we would use a highly porous titanium or tantalum component. With severe damage to the trunnion or extensive femoral osteolysis, we recommend femoral revision with a stem that obtains diaphyseal fixation. If ALTR caused severe abductor muscle or tendon damage, a dual-mobility or constrained liner could be considered. The extent of debridement of damaged tissues or pseudotumor is controversial in asymptomatic patients. Incomplete removal of affected tissue may be associated with pseudotumor recurrence or a nidus for infection. Debridement should not be radical and preserve unaffected tissue and neurovascular structures.