Evaluate the advantages and disadvantages of acetabular osteolysis
treatment options
Each technique for approaching the problem of acetabular osteolysis has
its unique benefits.
By Robert Press ORTHOPEDICS TODAY 2009; 29:10
Addressing acetabular osteolysis is possible through several different
options, and a number of factors unique to each patient should affect which
technique is used in their specific case, according to a New York orthopedist.
According to Edwin P. Su, MD, 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.
Edwin
P. Su
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.
Potential for instability
Moderator John J. Callaghan, MD, expressed some concern with the
stability of operations in which components are reused.
“It has been alluded to … but there is no question that when
you do these operations where you do not take out the cup, they are at a higher
risk for dislocation,” Callaghan said. “Do you do any sort of
postoperative bracing or casting in these cases?”
“Several studies have shown a high rate of dislocation, so I always
counsel them,” Su replied. “I do not routinely use any sort of
bracing ... I just really caution them to slow down to allow the soft tissues
to heal.”
For more information:
John J. Callaghan, MD, can be reached at University of Iowa
Hospitals and Clinics, 200 Hawkins Drive, Iowa City, Iowa 52242; 319-356-2223;
e-mail: john-callaghan@uiowa.edu. He consults for and receives
royalties from DePuy for hip replacement designs.
Edwin P. Su, MD, can be reached at Hospital for Special Surgery,
535 East 70th Street, New York, New York 10021; 212-606-1128; e-mail:
sue@hss.edu. He has no direct or
financial interest in any product or company mentioned in this article.
