Review Question - QID 8386

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THA Revision Surgical Techniques Combined revision QID: 8386 (SAE13HK.5)

QID 8386 (Type "8386" in App Search)

A 67-year-old active man returns for routine follow up 12 years after hip replacement. He has no hip pain. Radiographs revealed a well-circumscribed osteolytic lesion around a single acetabular screw. All hip components were perfectly positioned. Six months later, comparison radiographs show an increase in the size of the osteolytic lesion. A CT scan shows a well-described lesion that is 3 cm at its largest diameter and is localized around 1 screw hole with an eccentric femoral head. What treatment is appropriate, assuming well-fixed cementless total hip components exist?

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Revision of the polyethylene liner, removal of the screw, and debridement of the osteolytic lesion with or without bone grafting

82%

930/1139

Revision of the acetabular component to a newer design without screws

39/1139

Removal of the screw, revision of the polyethylene liner, and stem cell injection into the lytic lesion

15/1139

Removal of the offending screw from the metal socket and placement of a new polyethylene liner in the existing socket

12%

138/1139

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With a well-fixed acetabular metal shell and a localized osteolytic lesion, good outcomes can be expected with liner revision in this clinical scenario with retention of the metal socket, assuming no damage to the components or other unexpected findings during revision surgery. Here, complete cup revision is not warranted considering the appropriate implant position. Beaule and associates reviewed 83 consecutive patients (90 hips) in which a well-fixed acetabular component was retained in clinical scenarios such as the one described; no hip showed recurrence or expansion of periacetabular osteolytic lesions. If the metal cup is unstable, or if the osteolytic lesion is not amenable to debridement through the screw hole, acetabular component revision may be indicated.