J Korean Hip Soc.  2011 Dec;23(4):248-257. 10.5371/jkhs.2011.23.4.248.

Diagnosis and Treatment of Osteolysis

• Suh YS
• Won SH

• KMID: 1452631
• DOI: http://doi.org/10.5371/jkhs.2011.23.4.248

Abstract

Total hip replacement arthroplasty (THRA) is widely performed, and is a successful orthopedic treatment method. Osteolysis, which often happens after THRA, causes a chronic inflammation stage due to wear debris in the artificial articular surface, leading to bone loss or loosening of implants. Osteolysis eventually results in shortening the lifespan of the joint. Afterwards, many researchers reported on the basis of experiments with tissue cultivation that due to the influence of wear particles, the surrounding tissues of the implants as obtained during replacement and the surrounding cells of the implants are secreting enzymes, prostaglandin, cytokine, and the like that stimulate the formation of fibrous tissues or bone resorption by osteoclasts. At this time, THRA was a main cement fixation method, so researchers thought that the loose particles of cement were the cause of osteolysis and aseptic loosening, and so they named these symptoms "cement disease". However, despite the advancement of cement techniques and the use of cement-free implants, the osteolysis problem continued to rise, leading to polyethylene wear particles being regarded as the main cause of osteolysis, and naming these symptoms "particle disease". In this way attention was drawn to new wear particles, now that it is revealed that ultra-high-molecular-weight-polyethylene (UHMWPE) or metal particles constitute the main cause. However, because no symptoms arise until serious bone defects or loosening occurs, it is difficult to diagnose or treat the disease early on. Thus, based on updated hypotheses and theories, this study examines the pathophysiology of osteolysis following THRA, as well as the diagnosis and treatment of osteolysis in the acetabular and femoral regions.

Keyword

Osteolysis; Pathophysiology; Diagnosis and treatment

MeSH Terms

Arthroplasty
Arthroplasty, Replacement, Hip
Bone Resorption
Inflammation
Orthopedics
Osteoclasts
Osteolysis
Polyethylene
Polyethylene

Figure

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  Fig. 1 Osteolysis on acetabular and femoral area. (A) Combined deficiency on superior and anterior acetabular area, and severe proximal femoral bone loss with medial cortical bone breakage in 52-year-old man who underwent primary surgery before 20 years. (B) Hip lateral plain roentgenogram also shows severe osteolysis on acetbular and femoral area.

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  Fig. 2 CT scan helps to recognize more accurate location and size of osteolytic lesions. (A) Coronal image shows severe bone loss on acetabular and femoral area with medial cortical breakage. (B) Axial image shows more accurate combined bony deficiency on superior and anterior acetabular area.

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  Fig. 3 Revision surgery was accomplished by substitution of acetabular component, liner and femoral stem. (A) After cancellous bone grafting on combined acetabular deficiency area, acetabular component was well-fixed on postoperative pelvis AP plain roentgenogram. (B) On femoral side, reconstruction was accomplished by long stem with cortical allograft strut, trochanteric grip and cerclage wires.

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