This Article Full Text Full Text (PDF) CME: Take the activity for this article: Adult Hip Reconstruction Test 26: Fall 2007 (publication date November 15, ... Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Howie, D. W. Articles by Findlay, D. M. Search for Related Content PubMed PubMed Citation Articles by Howie, D. W. Articles by Findlay, D. M. Related Collections Adult Hip Social Bookmarking             What's this?

Progression of Acetabular Periprosthetic Osteolytic Lesions Measured with Computed Tomography

¹ Department of Orthopaedics and Trauma, Level 4, Bice Building, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia. E-mail address for S. Neale: susan.neale{at}health.sa.gov.au
² Department of Radiology, Level 3, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia

Investigation performed at the Department of Orthopaedics and Trauma and the Department of Radiology, Royal Adelaide Hospital, and the Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, Australia

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Health and Medical Research Council, Novartis Pharmaceuticals, Royal Adelaide Hospital, and Bristol-Myers Squibb/Zimmer. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Novartis Pharmaceuticals Australia Pty Ltd and Bristol-Myers Squibb/Zimmer) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Methods: We retrospectively analyzed quantitative computed tomography scans that had been made with use of a high-resolution multi-slice scanner with a metal artifact-suppression protocol. The scans had been made to determine the volume of osteolytic lesions around thirty-five cementless Harris-Galante acetabular components that had been in situ for at least ten years. Repeat scans of thirty hips allowed for the measurement of progression in the size of osteolytic lesions over a one-year period. Associations between the volume of osteolytic lesions, progression in the size of the lesions, polyethylene wear since the time of implantation, change in component position, and patient-related variables (age, gender, body mass index, activity level, walking limitations, joint pain, and function) were determined.

Results: In sixteen of the thirty hips that had repeat computed tomography scans, the lesions progressed in size during the study period. The median size of the lesions in these sixteen hips was 10.3 cm³ at the time of the initial scan, compared with 13.3 cm³ at a median of fifteen months later (p = 0.001). Osteolytic lesions measuring >10 cm³ in volume on the initial scan were 2.5 times (95% confidence interval 1.3 to 4.8 times) more likely to progress in size over one year than smaller lesions were. Patients with greater polyethylene wear rates, higher activity levels, no walking limitations, and larger prosthetic femoral head dimensions (26 or 28 mm) had significantly larger osteolytic lesions (p < 0.0001, p = 0.009, p = 0.006, and p = 0.028, respectively). Progression in the size of the osteolytic lesions over one year was significantly associated with larger initial osteolytic lesions (p = 0.002), greater polyethylene wear rates (p = 0.009), and larger (26 or 28-mm) prosthetic femoral head dimensions (p = 0.019).

Conclusions: There is considerable variation in the rates of progression of the size of osteolytic lesions around stable acetabular components. Lesion size and the progression of lesion size are generally related to polyethylene wear rates, higher patient activity levels, and larger-diameter femoral heads. Osteolytic lesions measuring >10 cm³ in volume are associated with a high rate of progression.

Level of Evidence: Prognostic Level III. See Instructions to Authors for a complete description of levels of evidence.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				M. H. Huo, J. Parvizi, B. S. Bal, and M. A. Mont What's New in Total Hip Arthroplasty J. Bone Joint Surg. Am., September 1, 2008; 90(9): 2043 - 2055. [Full Text] [PDF]

				E. M. Schwarz What potential biologic treatments are available for osteolysis? J. Am. Acad. Ortho. Surg., July 1, 2008; 16(suppl_1): S72 - S75. [Abstract] [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2007 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.