Retention of a well-fixed acetabular component in the setting of acetabular osteolysis

The treatment strategy for pelvic osteolysis with a well-fixed acetabular component after total hip arthroplasty (THA) involves replacing the acetabular cup liner and femoral head, d,briding osteolytic lesions, and grafting. We investigated whether retention of a well-fixed acetabular component using the two-approach technique-the ilioinguinal approach combined with the posterolateral approach-was compatible with socket survival. We reviewed clinical and radiographic findings for 24 patients (24 hips) who had undergone acetabular revision arthroplasty of a well-fixed socket for progressive osteolysis. The surgical techniques used included osteolytic lesion d,bridement and bone grafting through the ilioinguinal approach, and replacement of the acetabular liner and femoral head through the posterolateral approach. The mean duration of follow-up after revision was 2.3 (range 2.1-3.9) years. At follow-up evaluation, all acetabular components were well fixed and showed no evidence of loosening, osseous integration was apparent and there was no radiographic evidence that any lesions had progressed. No new osteolytic lesions were identified, and there were no clinical or radiographic complications. Curettage and bone grafting under direct vision, cup liner and femoral-head replacement because of progressive retroacetabular osteolysis and retention of well-fixed components using the two-approach technique results in good osseous integration of lysis. Larger studies with longer follow-up periods are required to establish the long-term success of this technique.