The fate of pelvic osteolysis after reoperation : No recurrence with lesional treatment

Twenty-three hips (21 patients) with 30 pelvic osteolytic lesions underwent reoperation and were observed prospectively for 25 to 74 months (average, 40 months) to assess the fate of pelvic osteolysis after reoperation. The average radiographic dimensions of the lytic lesions were 2.4 x 1.9 cm with the largest lesion measuring 7 x 5 cm. The porous ingrowth acetabular component shell had been left in situ in 15 hips and had been revised in eight. There was no difference in the average lesional size for hips with revised shells compared with those with unrevised shells. In cases where the shell was left in situ, the osteolytic lesions were curetted by working around the component perimeter or through holes in the shell. In 18 hips the bone defect(s) were grafted with autograft or allograft. Regardless of the management of the acetabular shell or the absence or presence of bone graft, none of the osteolytic lesions have progressed. Twenty-six of the 30 lesions have increased radiographic density. All acetabular components remain radiographically well fixed. There were no new osteolytic lesions. All hips were functioning well, and none have required subsequent reoperation for any reason. There was a statistically significant reduction in the operative time and the amount of blood loss when the acetabular component was not revised. It does not appear necessary to remove a well fixed and well positioned cementless acetabular component for the treatment of pelvic osteolysis. Debridement of periarticular inflammatory tissue and lesional curettage, either with or without bone graft, is effective in managing this type of bone loss. Revision of the acetabular component shell was associated with a significant increase in operative time and blood loss. These results support routine radiographic evaluation after total hip arthroplasty to monitor the development of osteolysis. On the basis of this experience, the authors recommend lesional treatment of progressive pelvic osteolysis to avoid more difficult surgery and minimize patient morbidity.