Radiographically Silent Loosening of the Acetabular Component in Hip Arthroplasty

Polyethylene wear and subsequent osteolysis are major obstacles to the long-term success of total hip arthroplasty (THA). We conducted a study to determine the incidence of loose acetabular components that did not show frank signs of loosening on either plain radiography or computed tomography (CT), or radiographically silent loosening (RSL). In this retrospective study, we evaluated patients who underwent revision THA and were evaluated with plain radiography and CT between 2000 and 2012. Any patient with imaging that showed signs of component movement was excluded. Of the 104 patients who met the study inclusion criteria, 17 (16.3%) met the criteria for RSL of the acetabular shell. Patients with RSL presented at a similar age (P = .961) and with a similar sex profile (P = .185) compared with patients with stable acetabular components and were more likely to present with pain (P = .0487). Acetabular components may be loose even if there is no evidence of component migration on radiographic studies. Surgeons should be aware of the incidence of RSL and the potential of RSL to affect patient care and potential surgical options.