THE FATE OF PELVIC OSTEOLYSIS AFTER REOPERATION - NO RECURRENCE WITH LESIONAL TREATMENT

Twenty-three hips (21 patients) with 30 pelvic osteolytic lesions unde rwent reoperation and were observed prospectively for 25 to 74 months (average, 40 months) to assess the fate of pelvic osteolysis after reo peration, The average radiographic dimensions of the lytic lesions wer e 2.4 x 1.9 cm with the largest lesion measuring 7 x 5 cm, The porous ingrowth acetabular component shell had been left in situ in 15 hips a nd had been revised in eight. There was no difference in the average l esional size for hips with revised shells compared with those with unr evised shells. In cases where the shell was left in situ, the osteolyt ic lesions were curetted by working around the component perimeter or through holes in the shell. In 18 hips the bone defect(s) were grafted with autograft or allograft, Regardless of the management of the acet abular shell or the absence or presence of bone graft, none of the ost eolytic lesions have progressed, Twenty-six of the 30 lesions have inc reased radiographic density, All acetabular components remain radiogra phically well fixed. There were no new osteolytic lesions. All hips we re functioning well, and none have required subsequent reoperation for any reason. There was a statistically significant reduction in the op erative time and the amount of blood loss when the acetabular componen t was not revised. It does not appear necessary to remove a well fixed and well positioned cementless acetabular component for the treatment of pelvic osteolysis. Debridement of periarticular inflammatory tissu e and lesional curettage, either with or without bone graft, is effect ive in managing this type of bone loss, Revision of the acetabular com ponent shell was associated with a significant increase in operative t ime and blood loss. These results support routine radiographic evaluat ion after total hip arthroplasty to monitor the development of osteoly sis, On the basis of this experience, the authors recommend lesional t reatment of progressive pelvic osteolysis to avoid more difficult surg ery and minimize patient morbidity.