Monitoring Pelvic Osteolysis Following Total Hip Replacement Surgery: An Algorithm for Surveillance

Osteolysis of the pelvis secondary to polyethylene wear of an uncemented acetabular implant has emerged as the most serious and challenging aseptic consequence of total hip replacement surgery 1-4. A very large number of patients have and will continue to be at risk for the development of osteolysis 2-13. The early detection of osteolysis allows the initiation of treatment programs that preserve bone stock 6,14-20. Because osteolysis occurs and progresses in the absence of clinical symptoms, appropriate follow-up surveillance must be instituted 7-9,13,21. Our initial study 22 of the usefulness of CT (computerized tomography) scans in the detection of clinically silent and radiographically unobservable osteolysis indicated that radiographs greatly understate the prevalence and location of osteolysis22-24 ( Figs. 1-A and 1-B ). The purpose of this study was to determine the prevalence of CT scan-identifiable osteolysis in young, active patients with a single cup design after a minimum duration of follow-up of seven years.