Noncemented acetabular component removal in the presence of osteolysis: the affirmative

The strategy for retention or removal of the acetabular component to address osteolytic activity is becoming an increasingly debated issue among joint replacement surgeons. It is paramount to the success of the revision surgery to eliminate the particulate debris source and thoroughly debride and graft the periacetabular regions. Visualization and complete access to all periacetabular regions require acetabular component removal. The authors present an opinion on acetabular component removal and introduce an impaction grafting method for addressing periacetabular osteolysis. The intermediate results at an average of 41 months are excellent with one patient requiring rerevision of the acetabular component at 83 months postoperative because of aseptic loosening. The outcome of revision total hip arthroplasty has been shown to be inferior to primary total hip arthroplasty, with each following revision having less probability for success equaling the preceding procedure. However, it is the authors' opinion that removing the entire acetabular component is the most prudent choice to eliminate and to avoid the introduction of adverse variables such as particulate debris and component malposition and nonconformity, which may contribute to the continuation of the osteolytic process.