Skip to main content
SpringerLink
Log in

Bone Defects in Acetabular Revision Surgery. Imaging and Classifications

  • Chapter
  • First Online:
Acetabular Revision Surgery in Major Bone Defects

  • 577 Accesses

Abstract

Acetabular bone defects determine the type of acetabular revision surgery. In order to avoid complications, preoperative planning must include patient evaluation, detailed imaging assessment of the bone defects, defect classification, and the proposed surgical reconstruction. Diagnosis of osteolysis and aseptic loosening is made based on serial radiographs, but potential difficulties in the presurgical evaluation require imaging techniques such as the use of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) to supplement information for radiographic assessment. Because of the complexity of acetabular revision surgery, the bone defects must be classified preoperatively in order to prepare the appropriate surgical technique. The definitive bone defects are evaluated intraoperatively after removal of the failed cup. A good bone defect classification system must be based on imaging findings, it must be validated by documented low rates of interobserver and intraobserver error prior before being accepted into routine usage, and it must be a guide to the surgeon that will facilitate choosing the right surgical technique.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Harris WH. Wear and periprosthetic osteolysis: the problem. Clin Orthop Relat Res. 2001;393:66–70.

    Article  Google Scholar 

  2. Schmalzried TP, Guttman D, Grecula M, Amstutz HC. The relationship between the design, physician, and articular wear of acetabular components inserted without cement and the development of pelvic osteolysis. J Bone Joint Surg Am. 1994;76-A(5):677–88.

    Article  Google Scholar 

  3. Schmalzried TP, Kwong OM, Jasty M, Sedlacek RC, Haire TC, O’Connor DO, Bragdon CR, Kabo JM, Malcolm AJ, Harris WH. The machanism of loosening and cemented acetabular components and total hip arthroplasty: analysis of specimens retrieved at autopsy. Clin Orthop Relat Res. 1991;274:60–78.

    Google Scholar 

  4. Schmalzried TP, Jasty M, Harris WH. Periprosthetic bone loss in total hip arthroplasty. Polyethylene wear debris and the concept of the effective joint space. J Bone Joint Surg Am. 1992;74-A(6):849–63.

    Article  Google Scholar 

  5. Ries MD, Link TM. Monitoring and risk of progression of osteolysis after total hip arthroplasty. In: Pagnano MW, Hart RA, editors. AAOS instructional course lectures. 2013;62:207–14.

    Google Scholar 

  6. Stamenkov R, Howie D, Taylor J, Findlay D, McGee M, Kourlis G, Carbone A, Burwell M. Measurement of bone defects adjacent to acetabular components of hip replacement. Clin Orthop Relat Res. 2003;412:117–24.

    Article  Google Scholar 

  7. Kitamura N, Naudie DD, Leung SB, Hooper RH Jr, Engh CA Sr. Diagnostic features of pelvic osteolysis associated with stable acetabulat component inserted without cement as part of a total hip replacement. J Bone Joint Surg Am. 2005;87-A(7):1542–50.

    Google Scholar 

  8. Maloney WJ, Paposky W, Engh CA, Rubash H. Surgical treatment of pelvic osteolysis. Clin Orthop Relat Res. 2001;393:78–84.

    Article  Google Scholar 

  9. Kobayashi A, Freeman MAR, Bonfield W, Kadoya Y, Yamac T. Number of polyethylene particles and osteolysis in total joints replacements. A quantitative study using a tissue-digestion method. J Bone Joint Surg Br. 1997;79-B(5):844–8.

    Article  Google Scholar 

  10. Maloney WJ, Smith RL. Periprosthetic osteolysis in total hip arthroplasty. The role of particulate wear debris. J Bone Joint Surg Am. 1995;77-A(9):1448–61.

    Article  Google Scholar 

  11. Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. Prospective analysis of preoperative and intraoperative investigation for the diagnosis of infection at the sites of two hundred and two revisión total hip arthroplasties. J Bone Joint Surg Am. 1999;81-A(5):672–83.

    Article  Google Scholar 

  12. Alexander DP, Frew N. Preoperative optimisation of anaemia for primary total hip arthroplasty: a systemic review. Hip Int. 2017;27(6):515–22.

    Article  Google Scholar 

  13. Gombotz H, Rehak PH, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark study. Transfusion. 2007;47(8):1468–80.

    Article  Google Scholar 

  14. Dunne JR, Malone D, Tracy JK, Gannon C, Napolitano LM. Perioperative anemia: an independent risk factor for infection, mortality, and resource utilization in surgery. J Surg Res. 2002;102(2):237–44.

    Article  Google Scholar 

  15. Bedair H, Yang J, Dwyer MK, McCarthy JC. Preoperative erytropoietin alpha reduces postoperative transfusions in THA and TKA by my not be cost-effective. Clin Orthop Relat Res. 2015;473(2):590–6.

    Article  Google Scholar 

  16. Welton KL, Jesse MK, Kraeutler MJ, Garabekyan T, Mei-Dan O. The anteroposterior pelvic radiograph. Acetabular and femoral measurements and relation to hip pathologies. J Bone Joint Surg Am. 2018;100-A:76–85.

    Article  Google Scholar 

  17. Masri BA, Masterson EL, Duncan CP. The classification and radiographic evaluation of bone loss in revision hip arthroplasty. Orthop Clin North Am. 1998;28(2):219–27.

    Article  Google Scholar 

  18. Judet R, Judet J, Letournel E. Fractures of the acetabulum: classification and surgical approaches for open reduction, preliminary report. J Bone Joint Surg Am. 1964;46-A:1615–46.

    Article  Google Scholar 

  19. Claus AM, Engh CA Jr, Sychterz CJ, Xenos JS, Orishimo KF, Engh CA Sr. Radiographic definition of pelvic osteolysis following total hip arthroplasty. J Bone Joint Surg Am. 2003;85-A(8):1519–26.

    Article  Google Scholar 

  20. Shon WY, Gupta S, Biswal S, Han SH, Hong SJ, Moon JG. Pelvic osteolysis relationship to radiographs and polyethylene wear. J Arthroplasty. 2009;24(5):743–50.

    Article  Google Scholar 

  21. Puri L, Wixson RL, Stern SH, Kohli J, Hendrix RW, Stulberg SD. Use of helical computed tomography for the assessment of acetabular osteolysis after total hip arthroplasty. J Bone Joint Surg Am. 2002;84-A(4):609–14.

    Article  Google Scholar 

  22. Southwell DG, Bechtold JE, Lew WD, Schmidt AH. Improving the detection of acetabular osteolysis using oblique radiographs. J Bone Joint Surg Br. 1999;81-B(2):289–95.

    Article  Google Scholar 

  23. Zimlich RH, Fehring TK. Underestimation of pelvic osteolysis: the value of the iliac oblique radiograph. J Arthroplasty. 2000;15(6):796–801.

    Article  CAS  Google Scholar 

  24. Robertson DD, Magid D, Poss R, Fishman EK, Brooker AF, Sledge CB. Enhanced computed tomographic techniques for the evaluation of total hip arthroplasty. J Arthroplasty. 1989;4(3):271–6.

    Article  CAS  Google Scholar 

  25. Claus AM, Totterman SM, Sychterz CJ, Tamez-Peña JG, Looney RJ, Engh CA Sr. Computed tomography to assess pelvic lysis after total hip replacement. Clin Orthop Relat Res. 2004;422:167–74.

    Article  Google Scholar 

  26. Walde TA, Weiland DE, Leung SB, Kitamura N, Sychterz CJ, Engh CA Jr, Claus AM, Potter HG, Engh CA Sr. Comparison of CT, MRI, and radiographs in assessing pelvic osteolysis. A cadaveric study. Clin Orthop Relat Res. 2005;437:138–44.

    Article  Google Scholar 

  27. Garcia-Cimbrelo E, Tapia M, Martin-Hervas C. Multislice computed tomography for evaluating acetabular defects in revision THA. Clin Orthop Relat Res. 2007;463(Oct):138–43.

    PubMed  Google Scholar 

  28. Leung S, Naudie D, Kitamura N, Walde T, Engh CA. Computed tomography in the assessment of periacetabular osteolysis. J Bone Joint Surg Am. 2005;87(3):592–7.

    Article  Google Scholar 

  29. Lee MJ, Kim S, Lee SA, Song HT, Huh YM, Kim DH, Han SH, Suh JS. Overcoming artifacts from metallic orthopedic implants at high-field-strength MR imaging and multi-detector CT. Radiographics. 2007;27(3):791–803.

    Article  Google Scholar 

  30. Chen CA, Chen W, Goodman SB, Hargreaves BA, Koch KM, Lu W, Brau AC, Draper CE, Delp SL, Gold GE. New MR imaging methods for metallic implants in the knee: artifacts corection and clinical impact. J Magn Reson Imaging. 2011;33(5):1121–7.

    Article  Google Scholar 

  31. Hayter CL, Koff MF, Shah KKM, Miller TT, Potter HG. MRI after arthroplasty: comparison of MAVRiC and conventional fast spin-echo techniques. AJR Am J Roentgenol. 2011;197(3):W405–11.

    Article  Google Scholar 

  32. Hayter CL, Koff MF, Porter HG. Magnetic resonance imaging of the postoperative hip. J Magn Reson Imaging. 2012;35(5):1013–25.

    Article  Google Scholar 

  33. Potter HG, Nestor BJ, Sofka CM, Ho ST, Peters SL, Salvati EA. Magnetic resonance imaging after total hip arthroplasty: evaluation of periprosthetic soft tissue. J Bone Joint Surg Am. 2004;86-A(9):1947–54.

    Article  Google Scholar 

  34. Cooper HJ, Ranawat AS, HGF P, Foo LF, Jawetz ST, Ranawat CS. Magnetic resonance imaging in diagnosis and management of hip pain after total hip arthroplasty. J Arthroplasty. 2009;24(5):661–7.

    Article  Google Scholar 

  35. Hayter CL, Potter HG, Su EP. Imaging of metal-on-metal resurfacing. Orthop Clin North Am. 2011;42(2):195–205.

    Article  Google Scholar 

  36. Williams DH, Greidanus NV, Masri BA, Duncan CP, Garbuz DS. Prevalence of pseudotumor in asymptomatic patients after metal-on-metal hip arthroplasty. J Bone Joint Surg Am. 2011;93-A(23):2164–71.

    Article  Google Scholar 

  37. Eftekhar NS, Nercessian O. Intrapelvic migration of total hip prostheses: operative treatment. J Bone Joint Surg. 1989;71-A(10):1480–6.

    Article  Google Scholar 

  38. Frandsen PA, Andersen E, Madsen F, Skjodt T. Garden’s classification of femoral neck fractures: an assessment of inter-observer variation. J Bone Joint Surg Br. 1988;70-B(4):588–90.

    Article  Google Scholar 

  39. D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SH, Wedge JH. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126–37.

    Google Scholar 

  40. Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6-year follow-up evaluation. J Arthroplasty. 1994;9(1):33–44.

    Article  CAS  Google Scholar 

  41. Gross AE, Duncan CP, Garbuz D, Mohamed EMZ. Revision arthroplasty of the acetabulum in association with loss of bone stock. J Bone Joint Surg Am. 1998;80-A(3):440–51.

    Article  Google Scholar 

  42. Berry DJ, Lewallen DG, Hanssen AD, Cabanela ME. Pelvic discontinuity in revision total hip arthroplasty. J Bone Joint Surg Am. 1999;81-A(12):1692–702.

    Article  Google Scholar 

  43. Saleh KJ, Holtzman J, Gafni A, Saleh L, Jaroszynski G, Wong P, Woodgate I, Davis A, Gross AE. Development, test reliability and validation of a classification for revision hip arthroplasty. J Orthop Res. 2001;19(1):50–6.

    Article  CAS  Google Scholar 

  44. Paprosky WG, Weeden SH, Howling JW Jr. Component removal in revision total hip arthroplasty. Clin Orthop Relat Res. 2001;393:181–93.

    Article  Google Scholar 

  45. Peters CL, Erickson JA, Dunn HK. Revision of well-fixed cementless acetabular components for polyethylene failure. Clin Orthop Relat Res. 2003;414:129–35.

    Article  Google Scholar 

  46. Mitchell PA, Masri BA, Garbuz DS, , Greidanus NV, Wilson D, Duncan CP. Removal of well-fixed, ccementless, acetabular components in revisión hip arthroplasty. J Bone Joint Surg Br 2000;85-B(7):949–952.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain

    Eduardo García-Rey

Authors
  1. Eduardo García-Rey
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Orthopaedic Surgery Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain

    Eduardo García-Rey

  2. Orthopaedic Surgery Department, Hospital Universitario La Paz-IdiPaz, Madrid, Spain

    Eduardo García-Cimbrelo

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

García-Rey, E. (2019). Bone Defects in Acetabular Revision Surgery. Imaging and Classifications. In: García-Rey, E., García-Cimbrelo, E. (eds) Acetabular Revision Surgery in Major Bone Defects. Springer, Cham. https://doi.org/10.1007/978-3-319-98596-1_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-98596-1_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-98595-4

  • Online ISBN: 978-3-319-98596-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation