TREATMENT OF FEMORAL OSTEOLYSIS WITH CEMENTLESS TOTAL HIP REVISION

Fifty-nine total hip revision arthroplasties using cementless femoral components were performed in patients with focal femoral osteolytic de fects before surgery. Clinical and radiographic review was performed a t 2 to 5 years of followup evaluation. Osteolytic defects were located by Gruen zones, evaluated on post-operative radiographs, and classifi ed as stabilized, progressive, regressing, healed, or new. There were no clinical failures in this series of patients, and no femoral revisi ons have been necessary. Progression of the lyric defects after revisi on did not occur. No new defects developed. Of the 154 preoperative os teolytic defects identified, 27 stabilized, 65 regressed, and 62 heale d. One goal of revision hip surgery is to prevent osteolytic lesions f rom progressing, and this was achieved in 100% of patients in this ser ies. Another goal of revision surgery is restoration of bone stock. It appears that there is a slow, steady remodeling of the lytic lesion t hat occurs with a well-fixed porous ingrowth prosthesis. Although this series did not show any additional benefit from cancellous allografti ng, the grafting technique did not use specifically designed instrumen tation. Therefore,:the full potential of grafting may not have been re alized. If severe osteolysis is present, then regression or healing of defects can be achieved by revision to a cementless femoral component with or without the addition of cancellous allograft.