title: Osteolysis in the well-fixed socket: cup retention or revision?
abstract: Osteolysis remains a common reason for revision   after total hip arthroplasty (THA). For osteolysis associated with loose   cups, revision is indicated. For osteolysis around a well-fixed   cup, the decision is more controversial. The data available data   support retention of the cupwith lesional treatment, working through   screw holes and access channels for debridement and grafting. The   choice of graft material to fill defects, if any, remains controversial. Several   studies demonstrate good survivorship with cup retention strategies.   Complete revision allows more complete debridement of the lesion   and better graft fill, and allows implantation of a modern cup,   typically with a full line of liners and bearing surfaces available.   Additionally, revision allows fine tuning of the orientation of   the cup, which may be advantageous for optimising hip stability.   The author prefers to retain a well-fixed cup if it meets the following   criteria: it is well-fixed to intra-operative testing, it is well-positioned,   it is of sufficient size to allow insertion of a new liner with   a reasonable head size, new liners are available, and the hip is   stable to intra-operative trialing after liner insertion.
authors.affiliation: Level One Orthopedics, 1222 S. Orange Avenue, 5th floor, Orlando, Florida 32806, USA. docgjh@aol.com
authors.forename: G J
authors.initials: GJ
authors.lastname: Haidukewych
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation / Q000379:methods; D016025:Bone Transplantation; D020878:Device Removal; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D010014:Osteolysis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D011300:Preoperative Care; D011475:Prosthesis Failure / Q000009:adverse effects; D011859:Radiography; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome