THE PROBLEM IS OSTEOLYSIS

Recent studies have generated considerable information that reveals su bstantial support for major change in the understanding of total hip a rthroplasty and its current state, Although some of these observations appear unrelated at first glance, they can be drawn together to suppo rt the thesis that osteolysis is the dominant problem in total hip art hroplasty, These observations are as follows: (1) Five-year followup d ata are required for a minimum assessment of a new concept in total hi p design and material because osteolysis is uncommon before that time, (2) Excellent fixation can be achieved on the femoral side with, good cementing and good cementless techniques, Thus, femoral component loo sening is less of an issue currently, (3) Many acetabular components b ecome loose because of the ingress of particulate debris that leads to linear bone loss at the interface with the pelvis, a process that is biologically akin to the more florid forms of osteolysis, Thus, much a cetabular component loosening represents a form of osteolysis, (4) Man y cementless femoral reconstructions have developed a high incidence o f femoral osteolysis, (5) Many cementless sockets have developed a hig h incidence of pelvic osteolysis, Taken in conjunction, these observat ions suggest that periprosthetic osteolysis is the leading problem in contemporary total hip replacement.