Our Summary

This research paper discusses the challenges of managing a common long-term complication of hip replacement surgery, called periacetabular osteolysis. This condition involves the breakdown of bone around the hip socket. The paper explores several options for dealing with this issue: regular check-ups, replacing the liner of the hip socket with or without bone grafting, and a complete revision of the hip replacement.

Before deciding on the best course of action, doctors need to carry out a thorough examination of the patient, including their medical history and imaging scans. Computed tomography (CT scans) are often used to assess the extent of the osteolysis.

If the hip replacement is still secure and well-positioned, and the patient is not experiencing symptoms or worsening osteolysis, and there are no signs of infection, it might be best to continue with regular monitoring. However, if scans reveal issues such as loosening of the hip replacement, poor positioning, osteolysis in a weight-bearing area, fractures, rapid osteolysis progression, or significant wear, surgery might be the best option.

In cases where the hip replacement is still well-positioned and secure, the decision about whether to have surgery should be discussed with the patient, taking into consideration the risk of further osteolysis progression and other patient-specific risk factors.

In some cases, it might be possible to replace the liner of the hip socket if the patient is not experiencing symptoms and the hip replacement is still stable. The paper notes that it is still unclear if filling in areas of osteolysis through screw holes or bone windows is beneficial in the long term.

FAQs

  1. What is periacetabular osteolysis and how does it relate to hip replacements?
  2. What are the possible treatments for osteolysis after a hip replacement surgery?
  3. How is it determined whether a hip replacement cup needs to be revised or retained?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hip replacement is to regularly attend follow-up appointments and imaging studies to monitor for any signs of periacetabular osteolysis, a common complication. Depending on the findings, the doctor may recommend different treatment options such as isolated liner exchange, complete cup revision, or simply continued monitoring. It is important to discuss these options with your doctor and make informed decisions based on your individual situation and risk factors.

Suitable For

Patients who are typically recommended for hip replacement are those who are experiencing severe hip pain, stiffness, and reduced mobility due to conditions such as osteoarthritis, rheumatoid arthritis, or avascular necrosis. These patients may have tried non-surgical treatments such as medication, physical therapy, or injections without success. Additionally, patients who have suffered a hip fracture or have a congenital hip deformity may also be candidates for hip replacement surgery. It is important for patients to undergo a thorough evaluation by a healthcare provider to determine if hip replacement is the best treatment option for their individual situation.

Timeline

Before hip replacement:

  1. Patient experiences persistent hip pain, stiffness, and limited mobility.
  2. Patient undergoes a thorough medical history, physical examination, and imaging studies to determine the need for hip replacement surgery.
  3. Decision is made to proceed with hip replacement surgery based on the severity of symptoms and imaging findings.

After hip replacement:

  1. Patient undergoes hip replacement surgery, during which the damaged hip joint is replaced with an artificial implant.
  2. Patient undergoes post-operative rehabilitation and physical therapy to regain strength and mobility in the hip joint.
  3. Patient experiences initial post-operative pain and discomfort, which gradually improves over time.
  4. Patient undergoes regular follow-up appointments with their healthcare provider for monitoring of the hip implant and overall hip function.
  5. In the long term, patient may develop periacetabular osteolysis as a complication of the hip replacement surgery, requiring further evaluation and possibly revision surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with hip replacement surgery?
  2. How long can I expect the hip replacement to last before needing a revision surgery?
  3. What type of implant will be used in the hip replacement surgery?
  4. Will I need physical therapy or rehabilitation after the surgery?
  5. How soon can I expect to return to normal activities and work after the surgery?
  6. What are the signs and symptoms of periacetabular osteolysis that I should watch out for?
  7. How often should I have follow-up appointments to monitor for osteolysis or other complications?
  8. What are the criteria for deciding whether to retain or revise the cup in the presence of osteolysis?
  9. What imaging tests will be used to assess for osteolysis before and after the surgery?
  10. What are the potential benefits and risks of isolated liner exchange versus complete cup revision in my specific case?

Reference

Authors: Lutz B, Faschingbauer M, Bieger R, Reichel H, Kappe T. Journal: Z Orthop Unfall. 2016 Aug;154(4):377-84. doi: 10.1055/s-0042-105212. Epub 2016 Jun 1. PMID: 27249047