J Korean Hip Soc JKHS The Journal of the Korean Hip Society 1226-9409 The Korean Hip Society 10.5371/jkhs.2010.22.1.58 Original Article Management of Osteolysis around a Stable Harris-Galante Acetabular Cup - Retention vs Revision of the Acetabular Component - Han Seung Beom MD Park Jong Hoon MD Kyeong Bong Soo MD Kim Tae Kwon MD Park Sang Won MD Department of Orthopedic Surgery, Korea University Anam Hospital, College of Medicine, Korea University, Seoul, Korea. Address reprint request to Sang Won Park, MD. Department of Orthopedic Surgery, Korea University Anam Hospital, Anam-dong 5-ga, Seongbug-gu, Seoul 136-705, Korea. TEL: +82-2-920-5924, FAX: +82-2-924-2471, parksw@korea.ac.kr 03 2010 31 03 2010 22 1 58 65 27 07 2009 20 10 2009 30 11 2009 Copyright © 2010 The Korean Hip Society 2010 Purpose

We analyzed and compared 30 clinical cases of acetabular osteolysis around a stably fixed acetabular cup, and this was managed by changing the liner along with retaining or revising the cup.

 Materials and Methods

We analyzed 30 patients who underwent acetabular component revision or retention with a bone graft for osteolysis around a stably fixed Harris-Galante acetabular cup and these patients were followed up for more than 2 years. There were 7 cases with a conserved the acetabular cup and only the liner was changed, and 23 cases with a totally revised acetabular component. We compared the size of the acetabular cup, the thickness of the polyethylene liner, the progression of osteolysis and the clinical outcomes.

 Results

The Harris hip score was improved in both groups. In the retention group, during an average of 59.9 months of follow up, 7 cases showed stable fixation and 3 cases showed locally advanced osteolysis. In the revision group, during an average of 57.2 months of follow up, all 20 cementless acetabular cups showed stable fixation.

 Conclusion

We suggest that in patients with osteolysis around the stable cementless acetabular cup, both methods show satisfactory clinical outcomes. But considering recurrence of osteolysis, cup revision is more reliable than changing the liner with a bone graft.

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Loosening after acetabular cup revision by cemented cup. (A) For osteolysis around acetabular cup, acetabular cup revision was performed. (B) After 4 years, revised acetabular cup was loosened again.

Osteolysis around retained acetabular cup. In 3 cases of 7 retained cup cases, osteolysis is developed around acetabular cup. One case is on zone 1, and other 2 cases are on zone 2.

(A) AP radiograph of 38-year-old male showed ankylosing spondylitis on both hip joints. (B) The patient underwent bilateral THA. (C) After 13 and 14 years, liner change was performed for left hip joint and cup revision was performed for right hip joint, respectively. (D) 4 and 6 years after revision surgery, the AP radiograph showed no recurrence of osteolysis.

Osteolysis around revised acetabular cup. There was no osteolysis around acetabular cup in revision group.

(A) AP radiograph of 29-year-old male showed avascular necrosis on right hip joint. (B) THA was performed. (C) 9 years later, follow up radiograph showed osteolysis (zone 1, 2) and liner wear on right hip joint. (D) Liner change was conducted with cup retention. (E) 5 years after acetabular revision, Harris hip score was improved to 92 points, but his AP radiograph showed focal osteolysis around acetabular cup (DeLee and Charnley zone 2).

Demographics of Patients

Comparison of Clinico-Radiologic Outcome

*HHS: Harris Hip Score

†Only one case was unstable which was used cemented acetabular cup

‡Of 3 cases, one case was occurred on zone 1, and others were on zone 2.