European Hip Society 11th Congress Stockholm, Sweden, 9-11 October 2014 (original) (raw)

A challenging aspect of revision hip arthroplasty is the treatment of osteolysis. A considerable number of patients with radiographic osteolysis have well-fixed components. Lesional treatment involves retaining the components, grafting the osteolytic areas and changing the bearing surface. It is particularly indicated in younger patients where more extensive surgery is not desirable unless absolutely necessary. objectives: The senior author has introduced this procedure into his practice in selected cases and has carefully evaluated it. We present mid-term results. methods: Between February 2006 and January 2011, 7 patients (8 hips) with significant osteolysis around well-fixed and orientated uncemented shells, either symptomatic or asymptomatic but radiologically progressive, underwent lesional treatment. There were 6 males and 1 female with average age of 55 (42-63). All had shells with screw(s) and a metal-on-polyethylene bearing. Average time from the index operation to revision was 16 years (9-22). The liner and screws were removed, the lytic area curetted and grafted and a new liner cemented into the shell after roughening of the back of the liner and shell. All patients were followed up clinically (OHS, WOMAC) and radiologically for an average of 5 years (3-8). results: Half of the patients (4 hips) showed complete resolution of the osteolytic area on the last follow-up radiographs. For the remaining half the osteolytic area has decreased in size. All patients showed improvements clinically. OHS improved from 14 (7-22) to 32 (19-41). WOMAC score was 57 (45-75) before and 32 (14-59) after surgery. None of them had re-revision. Conclusions: The timing and appropriate treatment for osteolytic areas around a well-fixed cementless cup is controversial. Lesional treatment and changing the bearing has proved to be effective in well selected cases. We recommend this technique in cases with well-fixed and well-positioned sockets. Cemented reVision total hip arthroplasty with use of Both aCetaBular and femoral impaCtion Bone-GraftinG in patients younGer than 55 years