Evaluate the advantages and disadvantages of acetabular osteolysis treatment options

Orthopedics Today—September 29, 2009   

According to Edwin P. Su, MD, of Hospital for Special Surgery, the challenges in managing acetabular osteolysis involve detection, knowing when to intervene and choosing the best reconstructive option. His presentation at the 2009 Current Concepts in Joint Replacement Spring Meeting focused on the latter two challenges.

“Once you have decided to intervene, the goals of surgical treatment should be to arrest the osteolytic process, to debulk the biological response via complete synovectomy and removal of wear debris, to replenish bone stock, to exchange bearing services, and potentially take advantage of an increased head size,” he said.

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In surgery, the two options for addressing osteolysis are a liner exchange with or without bone grafting or, alternatively, complete component revision.

An isolated liner exchange is a faster surgery, it lacks of bony disruption, has a quicker recovery time and cost. However, it also can lead to instability and may be limited by the existing implant.

Complete revision gives access to lytic lesions, allows modification of component position and the use of newer technologies. It also has bony disruption and increased costs and recovery time.

Balancing factors

Su said you have to balance the variables: to retain or revise the shell, or choosing to do a less-invasive procedure which may require future surgery.

If the lesions can be accessed easily through screw holes or a makeshift “trap door,” retaining the shell is the obvious choice, Su said. But, if the component position is poor, it is better to revise the shell.

Read the full story at orthopedicsupersite.com.