, Volume 468, Issue 2, pp 480-490
Date: 22 Aug 2009

A Three-dimensional Method for Evaluating Changes in Acetabular Osteolytic Lesions in Response to Treatment

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The treatment of asymptomatic osteolysis among well-fixed cementless cups remains controversial. To compare the effectiveness of different treatment strategies, an objective technique for evaluating bone remodeling would be useful. By matching and comparing serial CT images with the aid of a computer-assisted imaging program, we developed a method to evaluate three-dimensional mineralization changes within osteolytic defects. Preoperative, immediate postoperative, and followup CT images were normalized based on a phantom with known densities and matched using image registration so that the same region could be analyzed on each image. New bone mineralization within the preoperative osteolytic lesion volume was quantified based on a patient-specific trabecular bone density threshold. As a pilot study, we applied this technique in 10 patients treated by polyethylene liner exchange with débridement and grafting of periacetabular osteolytic lesions using a calcium sulfate bone graft substitute. Relative to the preoperative osteolytic lesion volume, an average of 43% (range, 8%–72%) of each defect was filled with graft at revision. After resorption of the graft, an average of 24% (range, 9%–44%) of the original defect volume demonstrated evidence of new mineralization at 1-year followup. The amount of new mineralization was directly proportional (r2 = 0.70) to the defect filling achieved at revision. CT-based image analysis offers an objective method for quantifying three-dimensional bone remodeling and can be used to evaluate the effectiveness of osteolysis treatment strategies.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

One of more of the authors (RH, CAE Jr, CAE) have received funding through a cooperative agreement awarded and administered by the US Army Medical Research & Materiel Command (USAMRMC) and the Telemedicine & Advanced Technology Research Center (TATRC) under Contract Number W81XWH-05-2-0079; general funding for the Anderson Orthopaedic Research Institute was provided by Inova Health Services.
Each author certifies that his or her institution has approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.