Do osteoarthritic subchondral bone cysts spontaneously consolidate after total hip replacement?

Abstract

Background:

During total hip replacement (THR), subchondral acetabular bone cysts are either left alone or treated by filling with autologous bone graft. We hypothesized that subchondral cysts would consolidate spontaneously over time without compromising the midterm survival of the implant.

Methods:

We retrospectively screened the anteroposterior hip radiographs of 731 consecutive patients who underwent primary THR between January 2006 and April 2009. Patients were included in the current study if they had acetabular subchondral bone cysts visible radiographically that had been left alone during THR.

Results:

52 patients (54 hips) matched the inclusion criteria, with mean age of 66 ± 11 years at surgery, and a mean follow-up of 6.3 years (range 5–9 years). Among the 52 patients, there were 88 cysts, with 1.6 ± 0.83 cysts per patient and a mean cyst size of 9.3 ± 10 mm² (range 0.9–57 mm²). Among the 88 cysts, 71 cysts (38 hips) had disappeared by the final follow-up, whereas 17 cysts (16 hips) were still visible. Most of these persistent cysts were located in Charnley zone I and were significantly smaller at the follow-up than before surgery (p = 0.015). Overall, most cysts decreased in size (p = 0.04). All cups survived and none showed radiological signs of loosening.

Conclusions:

After THR, most neglected subchondral cysts spontaneously consolidate or decrease in size. Larger cysts may persist without affecting the surgical outcome. No radiological signs of loosening or other adverse effects were observed when acetabular bone cysts are neglected during primary THR.

Keywords

Acetabulum arthroplasty bone cysts hip prosthesis failure replacement

Get full access to this article

View all access options for this article.

References

Landells

JW.

The bone cysts of osteoarthritis. J Bone Joint Surg Br 1953; 35: 643–649.

Schmalzried

Akizuki

Fedenko

et al . The role of access of joint fluid to bone in periarticular osteolysis. A report of four cases. J Bone Joint Surg Am 1997; 79: 447–452.

Rhaney

Lamb

DW.

The cysts of osteoarthritis of the hip; a radiological and pathological study. J Bone Joint Surg Br 1955; 37-B: 663–675.

Ondrouch

AS.

Cyst formation in osteoarthritis. J Bone Joint Surg Br 1963; 45: 755–760.

Inui

Nakano

Yoshioka

et al . Subchondral cysts in dysplastic osteoarthritic hips communicate with the joint space: analysis using three-dimensional computed tomography. Eur J Orthop Surg Traumatol 2013; 23: 791–795.

Engh

Jr Sychterz

Young

et al . Interobserver and intraobserver variability in radiographic assessment of osteolysis. J Arthroplasty 2002; 17: 752–759.

DeLee

Charnley

Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res 1976; 121: 20–32.

Nakamura

Naito

Akiyoshi

et al . Acetabular cysts heal after successful periacetabular osteotomy. Clin Orthop Relat Res 2007; 454: 120–126.

Mechlenburg

Nyengaard

Gelineck

et al . Cyst volume in the acetabulum and femoral head decreases after periacetabular osteotomy. Hip Int 2012; 22: 313–318.

10.

Kelly

Kitamura

Leung

et al . The natural history of osteoarthritic bone cysts after uncemented total hip arthroplasty. J Arthroplasty 2007; 22: 1137–1142.

11.

Rees

Hill

Cassar-Pullicino

et al . The incidence, location and distribution of degenerative subchondral acetabular cysts in primary osteoarthritis of the hip. Hip Int 2004; 14: 24–27.