The radiograph demonstrates osteolytic lesions behind the acetabular cup and eccentric wear of the polyethylene with superior migration of the femoral head within the cup. Options 1 and 2 are poor choices because the osteolysis must be addressed to prevent further bone loss and eventual loosening of the implant. The acetabular cup remains in acceptable position and does not need to be revised unless found to be grossly loose intraoperatively. The osteolytic lesions need to be addressed with bone grafting to prevent cavitary bone loss. The femoral stem shows no indication of loosening or osteolysis around the stem and can be retained.
Maloney et al reported a case series of 35 patients who underwent femoral head and polyethylene exchange with retroacetabular bone grafting of osteolytic lesions. All 35 cups remained stable and had not been revised at 2 years.
Maloney et al discusses the treatment of osteolytic defects following hip and knee arthroplasty at the 2007 Implant Wear Symposium.
Maloney WJ, Herzwurm P, Paprosky W, Rubash HE, Engh CA. 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 Nov;79(11):1628-34.
PMID:9384421 (Link to Abstract)
Maloney W, Rosenberg A; Implant Wear Symposium 2007 Clinical Work Group. What is the outcome of treatment for osteolysis? J Am Acad Orthop Surg. 2008;16 Suppl 1:S26-32.
PMID:18612010 (Link to Abstract)