What are the guidelines for the surgical and nonsurgical treatment of periprosthetic osteolysis?
Periprosthetic osteolysis is most often diagnosed by plain radiographs. Because these radiographs routinely underestimate the extent of the lesion, three-dimensional imaging should be used early in the evaluation process to confirm the presenting extent of disease. If the osteolytic process is asymptomatic, scheduled regular follow-up should be instituted until the lesion can be confirmed to be stable or until the decision is made to proceed with surgery. Nonsurgical management with pharmacologic agents has not proved to be effective. If surgery is contemplated, a three-dimensional evaluation with magnetic resonance imaging or helical computed tomography can assist in preoperative planning. Surgical intervention requires complete débridement of the lesional membrane and removal of the wear-generator--with or without component removal and with or without bone grafting, depending on the individual circumstances. A standardized follow-up evaluation mechanism for all patients should be a part of total joint arthroplasty management.
Stulberg
Bernard N
BN
Center for Joint Reconstruction, Cleveland Orthopaedic and Spine Hospital at Lutheran, Cleveland Clinic Health System, Cleveland, OH, USA.
Della Valle
Alejandro González
AG
D000077:Acetabulum / Q000473:pathology / Q000601:surgery; D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D001672:Biocompatible Materials / Q000009:adverse effects; D002985:Clinical Protocols; D003646:Debridement; D006801:Humans; D007595:Joint Prosthesis; D010014:Osteolysis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000379:methods / Q000592:standards
D001672:Biocompatible Materials