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. Well-fixed, 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.
From the Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA (Dr. Sheth and Dr. Rozell), and the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL (Dr. Paprosky).
Dr. Sheth or an immediate family member serves as a paid consultant to Smith & Nephew and Zimmer Biomet. Dr. Paprosky or an immediate family member has received royalties from Intellijoint, Stryker, and Zimmer Biomet; serves as a paid consultant to DePuy Synthes, Medtronic, Stryker, and Zimmer Biomet; has stock or stock options held in Intellijoint; has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Cadence Health; and serves as a board member, owner, officer, or committee member of The Hip Society. Neither Dr. Rozell nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.