Femoral osteolysis around the unrevised stem during isolated acetabular revision.
Many surgeons treat progressive femoral osteolysis in association with a well-fixed stem with bone grafting but in uncontained proximal defects the graft could get into the joint, raising a question regarding whether the osteolysis can be treated by simple débridement without bone grafting. We investigated whether the curetted proximal osteolysis around an unrevised femoral component progressed in size and whether this lesion would have a deleterious effect on fixation of the femoral component in patients with isolated acetabular revision. We prospectively followed 21 patients (24 hips) who underwent acetabular revision and curetting of femoral osteolysis. The minimum followup was 3 years (mean, 4.3 years; range, 3-7.4 years). By the latest followup, no hips had major progression of the osteolytic defect through the followup period and none had any new osteolytic lesions. All hips were judged stable and to have well-fixed acetabular cups and femoral stems. Provided a femoral component is bone ingrown with osseointegration sufficient to provide long-term stability, the osteolytic defect is in the proximal aspect of the femur, and the defect is uncontained, simple curettage may preserve femoral implant stability and may prevent progression of osteolysis to another Gruen zone for at least 3 to 7 years.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Min
Byung-Woo
BW
Department of Orthopedic Surgery, School of Medicine, Keimyung University, Dongsan Medical Center, 194 Dongsan-dong, Joong-gu, Daegu, 700-712, South Korea. min@dsmc.or.kr
Song
Kwang-Soon
KS
Cho
Chul-Hyun
CH
Bae
Ki-Cheor
KC
Lee
Kyung-Jae
KJ
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D003646:Debridement; D018450:Disease Progression; D005260:Female; D005270:Femur Head / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D016348:Osseointegration; D010014:Osteolysis / Q000209:etiology* / Q000601:surgery*; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
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