Isolated Liner Exchange and Bone Grafting for the Management of Periacetabular Osteolysis in Well-Fixed Cups with an Intact Locking Mechanism at Short-Term to Medium-Term Follow-Up: A Systematic Review
Restricted accessReview articleFirst published online November, 2024
Isolated Liner Exchange and Bone Grafting for the Management of Periacetabular Osteolysis in Well-Fixed Cups with an Intact Locking Mechanism at Short-Term to Medium-Term Follow-Up: A Systematic Review
Background: Polyethylene liner exchange and bone grafting is an effective surgical option for the management of periacetabular osteolysis following total hip arthroplasty with well-fixed cups and intact liner locking mechanisms. Purpose: We aimed to evaluate the revision-free survivorship and radiographic lesion progression after polyethylene liner exchange and bone grafting is performed for periacetabular osteolysis. Methods: A systematic review of the literature was performed. We queried Medline, EMBASE, and Cochrane Library for articles published from January 1999 to January 2023 using the following keywords: “osteolysis” AND “well-fixed,” “osteolysis” AND “retro-acetabular,” “bone graft” AND (“retention” OR “retained” OR “stable”) AND “cup,” and “uncemented liner” AND “well-fixed.” Results: Of 596 articles found, 9 articles were selected for final inclusion (227 cases, mean follow-up time 43.6 months). The overall cup revision rate after liner exchange was 6.6% (15 hips) due to progressive osteolysis (5 hips), aseptic loosening of the acetabular component (5 hips), dislocation (4 hips), and periprosthetic infection (1 hip). There was either radiographic resolution or regression of periacetabular osteolysis in all reported cases that provided measurements (52 hips) except 1 (1.9%) requiring revision. All studies reporting clinical outcomes indicated improved pain and functional scores. Conclusion: This systematic review found that isolated liner exchange with bone grafting for the management of periacetabular osteolysis was associated with a high revision-free survival rate (93.4%) and minimal radiographic progression (1.9%) of osteolytic lesions at short-term to medium-term follow-up. Liner exchange with bone grafting is recommended for the management of large periacetabular osteolytic lesions (> 450 mm2) in well-fixed acetabular cups. We encourage future studies to develop a grading scale for lesions to guide clinical management and risk stratification for patients.
Alexander-MalahiasMDe MartinoIGuA, et al. Complete wear-through of a metal-backed acetabular cup in an ambulatory patient. Arthroplast Today. 2019;5(4):394–400. https://doi.org/10.1016/j.artd.2019.09.008.
2.
BanerjeeSIssaKKapadiaBH, et al. Systematic review on outcomes of acetabular revisions with highly-porous metals. Int Orthop. 2014;38(4):689–702. https://doi.org/10.1007/s00264-013-2145-5.
3.
BerryDJvon KnochMSchleckCDHarmsenWS. Effect of femoral head diameter and operative approach on risk of dislocation after primary total hip arthroplasty. J Bone Joint Surg Am. 2005;87(11):2456–2463. https://doi.org/10.2106/JBJS.D.02860.
4.
BlomAWAstleLLoveridgeJLearmonthID. Revision of an acetabular liner has a high risk of dislocation. J Bone Joint Surg Br. 2005;87(12):1636–1638. https://doi.org/10.1302/0301-620X.87B12.16349.
5.
BobynJDStackpoolGJHackingSATanzerMKrygierJJ. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg Br. 1999;81(5):907–914. https://doi.org/10.1302/0301-620x.81b5.9283.
6.
BroomfieldJAMalakTTThomasGE, et al. The relationship between polyethylene wear and periprosthetic osteolysis in total hip arthroplasty at 12 years in a randomized controlled trial cohort. J Arthroplasty. 2017;32(4):1186–1191. https://doi.org/10.1016/j.arth.2016.10.037.
ClausAMTottermanSMSychterzCJ, et al. Computed tomography to assess pelvic lysis after total hip replacement. Clin Orthop Relat Res. 2004;422:167–174. https://doi.org/10.1097/01.blo.0000129345.22322.8a.
9.
DapuntUGieseTLasitschkaF, et al. Osteoclast generation and cytokine profile at prosthetic interfaces: a study on tissue of patients with aseptic loosening or implant-associated infections. Eur J Inflamm. 2014;12(1):147–159. https://doi.org/10.1177/1721727X1401200114.
10.
DeheshiBMAllenDJKimPR. Treatment of retroacetabular osteolysis with calcium sulfate and retention of original components. J Arthroplasty. 2008;23(8):1240.e9–12. https://doi.org/10.1016/j.arth.2007.11.013.
11.
DeLeeJGCharnleyJ. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res. 1976;121:20–32.
12.
EarllMDFehringTKGriffinWL, et al. Success rate of modular component exchange for the treatment of an unstable total hip arthroplasty. J Arthroplasty. 2002;17(7):864–869. https://doi.org/10.1054/arth.2002.34823.
13.
EnghCAJrHopperRHJrHuynhC, et al. A prospective, randomized study of cross-linked and non-cross-linked polyethylene for total hip arthroplasty at 10-year follow-up. J Arthroplasty. 2012;27(8)(suppl):2–7.e1. https://doi.org/10.1016/j.arth.2012.03.048.
14.
EtienneGBezwadaHPHungerfordDSMontMA. The incorporation of morselized bone grafts in cementless acetabular revisions. Clin Orthop Relat Res. 2004;428:241–246. https://doi.org/10.1097/01.blo.0000145889.94276.61.
González della ValleARuzoPSLiS, et al. Dislodgment of polyethylene liners in first and second-generation Harris-Galante acetabular components. A report of eighteen cases. J Bone Joint Surg Am. 2001;83(4):553–559. https://doi.org/10.2106/00004623-200104000-00010.
GriffinWLFehringTKMasonJB, et al. Early morbidity of modular exchange for polyethylene wear and osteolysis. J Arthroplasty. 2004;19(7)(suppl 2):61–66. https://doi.org/10.1016/j.arth.2004.06.014.
19.
GuXHeJTangY, et al. Comparison of polyethylene wear before and after hip revision with liner exchange fixed with the original locking mechanism. PLoS One. 2016;11(12):e0167607. https://doi.org/10.1371/journal.pone.0167607.
20.
HallAEilersMHansenR, et al. Advances in acetabular reconstruction in revision total hip arthroplasty: maximizing function and outcomes after treatment of periacetabular osteolysis around the well-fixed shell. J Bone Joint Surg Am. 2013;95(18):1709–1718. https://doi.org/10.2106/JBJS.9518icl.
21.
HarrisWHSchillerALSchollerJMFreibergRAScottR. Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am. 1976;58(5):612–618.
22.
HermidaJCBergulaAChenPColwellCWJrD’LimaDD. Comparison of the wear rates of twenty-eight and thirty-two-millimeter femoral heads on cross-linked polyethylene acetabular cups in a wear simulator. J Bone Joint Surg Am. 2003;85(12):2325–2331. https://doi.org/10.2106/00004623-200312000-00009.
23.
HozackWJMesaJJCareyCRothmanRH. Relationship between polyethylene wear, pelvic osteolysis, and clinical symptomatology in patients with cementless acetabular components. A framework for decision making. J Arthroplasty. 1996;11(7):769–772. https://doi.org/10.1016/s0883-5403(96)80175-6.
24.
KangPYangJZhouZShenBPeiF. Retention of a well-fixed acetabular component in the setting of acetabular osteolysis. Int Orthop. 2012;36(5):949–954. https://doi.org/10.1007/s00264-011-1372-x.
25.
KimKWYooJJKimMNKimHJ. Isolated acetabular liner exchange for polyethylene wear and osteolysis with well-fixed metal shell. Clin Orthop Surg. 2019;11(3):270–274. https://doi.org/10.4055/cios.2019.11.3.270.
26.
KobayashiNInabaYUchiyamaM, et al. Teriparatide versus alendronate for the preservation of bone mineral density after total hip arthroplasty—a randomized controlled trial. J Arthroplasty. 2016;31(1):333–338. https://doi.org/10.1016/j.arth.2015.07.017.
27.
KohKHMoonYWLimSJ, et al. Complete acetabular cup revision versus isolated liner exchange for polyethylene wear and osteolysis without loosening in cementless total hip arthroplasty. Arch Orthop Trauma Surg. 2011;131(11):1591–1600. https://doi.org/10.1007/s00402-011-1338-x.
28.
KurtzSMGawelHAPatelJD. History and systematic review of wear and osteolysis outcomes for first-generation highly crosslinked polyethylene. Clin Orthop Relat Res. 2011;469(8):2262–2277. https://doi.org/10.1007/s11999-011-1872-4.
29.
LeePCShihCHChenWJTuYKTaiCL. Early polyethylene wear and osteolysis in cementless total hip arthroplasty: the influence of femoral head size and polyethylene thickness. J Arthroplasty. 1999;14(8):976–981. https://doi.org/10.1016/s0883-5403(99)90013-x.
30.
LeungSNaudieDKitamuraNWaldeTEnghCA. Computed tomography in the assessment of periacetabular osteolysis. J Bone Joint Surg Am. 2005;87(3):592–597. https://doi.org/10.2106/JBJS.D.02116.
31.
LieSAHallanGFurnesOHavelinLIEngesaeterLB. Isolated acetabular liner exchange compared with complete acetabular component revision in revision of primary uncemented acetabular components: a study of 1649 revisions from the Norwegian Arthroplasty Register. J Bone Joint Surg Br. 2007;89(5):591–594. https://doi.org/10.1302/0301-620X.89B5.18623.
32.
LochnerKFritscheAJonitzA, et al. The potential role of human osteoblasts for periprosthetic osteolysis following exposure to wear particles. Int J Mol Med. 2011;28(6):1055–1063. https://doi.org/10.3892/ijmm.2011.778.
MalahiasMAMaQLJangSJ, et al. Polyethylene liner cementation into a well-fixed metal acetabular shell for the management of periacetabular osteolysis: a systematic review. Eur J Orthop Surg Traumatol. 2022;32(8):1459–1468. https://doi.org/10.1007/s00590-021-03130-w.
35.
MallNANunleyRMZhuJJ, et al. The incidence of acetabular osteolysis in young patients with conventional versus highly crosslinked polyethylene. Clin Orthop Relat Res. 2011;469(2):372–381. https://doi.org/10.1007/s11999-010-1518-y.
36.
MaloneyWJGalanteJOAndersonM, et al. Fixation, polyethylene wear, and pelvic osteolysis in primary total hip replacement. Clin Orthop Relat Res. 1999;369:157–164. https://doi.org/10.1097/00003086-199912000-00016.
37.
MaloneyWJHerzwurmPPaproskyWRubashHEEnghCA. Treatment of pelvic osteolysis associated with a stable acetabular component inserted without cement as part of a total hip replacement. J Bone Joint Surg Am. 1997;79(11):1628–1634. https://doi.org/10.2106/00004623-199711000-00003.
38.
MaloneyWJJastyMHarrisWHGalanteJOCallaghanJJ. Endosteal erosion in association with stable uncemented femoral components. J Bone Joint Surg Am. 1990;72(7):1025–1034.
MitchellPAMasriBAGarbuzDS, et al. Removal of well-fixed, cementless, acetabular components in revision hip arthroplasty. J Bone Joint Surg Br. 2003;85(7):949–952. https://doi.org/10.1302/0301-620x.85b7.13593.
41.
NarkbunnamRAmanatullahDFElectricwalaAJ, et al. Outcome of 4 surgical treatments for wear and osteolysis of cementless acetabular components. J Arthroplasty. 2017;32(9):2799–2805. https://doi.org/10.1016/j.arth.2017.04.028.
42.
PaproskyWGPeronaPGLawrenceJM. Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplasty. 1994;9(1):33–44. https://doi.org/10.1016/0883-5403(94)90135-x.
43.
PuriLWixsonRLSternSH, et al. Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty. J Bone Joint Surg Am. 2002;84(4):609–614. https://doi.org/10.2106/00004623-200204000-00016.
44.
RestrepoCGhanemEHoussockC, et al. Isolated polyethylene exchange versus acetabular revision for polyethylene wear. Clin Orthop Relat Res. 2009;467(1):194–198. https://doi.org/10.1007/s11999-008-0533-8.
45.
RitterMAHartyLDKeatingMEFarisPMMedingJB. A clinical comparison of the anterolateral and posterolateral approaches to the hip. Clin Orthop Relat Res. 2001;385:95–99. https://doi.org/10.1097/00003086-200104000-00016.
46.
RobinsonRPRobinsonHJJrSalvatiEA. Comparison of the transtrochanteric and posterior approaches for total hip replacement. Clin Orthop Relat Res. 1980;147:143–147.
47.
SalehKJHoltzmanJGafni ASalehL, et al. Development, test reliability and validation of a classification for revision hip arthroplasty. J Orthop Res. 2001;19(1):50–56. https://doi.org/10.1016/S0736-0266(00)00021-8.
48.
SandgrenBCrafoordJOlivecronaHGarellickGWeidenhielmL. Risk factors for periacetabular osteolysis and wear in asymptomatic patients with uncemented total hip arthroplasties. Scientific World Journal. 2014;2014:905818. https://doi.org/10.1155/2014/905818.
49.
SchmalzriedTPFowbleVAAmstutzHC. The fate of pelvic osteolysis after reoperation. No recurrence with lesional treatment. Clin Orthop Relat Res. 1998;350:128–137.
50.
ShethNPRozellJCPaproskyWG. Evaluation and treatment of patients with acetabular osteolysis after total hip arthroplasty. J Am Acad Orthop Surg. 2019;27(6):e258–e267. https://doi.org/10.5435/JAAOS-D-16-00685.
51.
SmithTMBerendKRLombardiAVJrMalloryTHRussellJH. Isolated liner exchange using the anterolateral approach is associated with a low risk of dislocation. Clin Orthop Relat Res. 2005;441:221–226. https://doi.org/10.1097/01.blo.0000194091.10447.79.
52.
TalmoCTKwonYMFreibergAARubashHEMalchauH. Management of polyethylene wear associated with a well-fixed modular cementless shell during revision total hip arthroplasty. J Arthroplasty. 2011;26(4):576–581. https://doi.org/10.1016/j.arth.2010.05.028.
53.
TelleriaJJGeeAO. Classifications in brief: Paprosky classification of acetabular bone loss. Clin Orthop Relat Res. 2013;471(11):3725–3730. https://doi.org/10.1007/s11999-013-3264-4.
54.
WalmsleyDWWaddellJPSchemitschEH. Isolated head and liner exchange in revision hip arthroplasty. J Am Acad Orthop Surg. 2017;25(4):288–296. https://doi.org/10.5435/JAAOS-D-15-00144.
55.
WooRYMorreyBF. Dislocations after total hip arthroplasty. J Bone Joint Surg Am. 1982;64(9):1295–1306.
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