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Retroacetabular osteolysis: when to operate?

Ramin Mehin1, Xunhua Yuan, Christopher Haydon

  • 1Division of Orthopaedic Surgery, London Health Sciences Centre-University Campus, London, Ontario, Canada. rmehin@hotmail.com

Clinical Orthopaedics and Related Research
|November 10, 2004
PubMed
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Retroacetabular osteolysis around cementless hip shells requires timely intervention. Measuring 50% shell circumference with osteolysis on anteroposterior radiographs predicts impending loosening, guiding polyethylene liner exchange.

Area of Science:

  • Orthopedic surgery
  • Biomedical engineering
  • Radiology

Background:

  • Aseptic osteolysis is a common complication of cementless hip arthroplasty.
  • Polyethylene liner exchange is indicated before cementless shell loosening occurs.
  • Predicting impending shell loosening is crucial for successful revision surgery.

Purpose of the Study:

  • To identify radiographic indicators of osteolysis that predict impending loosening of cementless acetabular shells.
  • To establish a quantitative measure of osteolysis for timely polyethylene liner exchange.

Main Methods:

  • Retrospective review of 46 cementless shells revised for aseptic osteolysis between 1992 and 2002.
  • Quantification of osteolysis using radiographs and a computer-assisted technique.

Related Experiment Videos

  • Intraoperative confirmation of implant stability (stable vs. loose shells).

    • Main Results:

    • No significant difference in average osteolytic area on anteroposterior radiographs between stable and loose shells.
    • Significant differences in average osteolytic area on lateral radiographs and percentage of shell circumference with osteolysis on both views.
    • A diagnostic criterion of 50% shell circumference with osteolysis on anteroposterior radiographs showed high sensitivity (1.0) and moderate specificity (0.27) for predicting shell loosening.

    Conclusions:

    • The percentage of shell circumference affected by osteolysis is a more reliable predictor of loosening than the area of osteolysis.
    • Consider polyethylene liner exchange when 50% of the shell circumference shows osteolysis on anteroposterior radiographs to prevent compromised shell fixation.