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What are the guidelines for the surgical and nonsurgical treatment of periprosthetic osteolysis?

Dr. Stulberg is Director, Center for Joint Reconstruction, Cleveland Orthopaedic and Spine Hospital at Lutheran, Cleveland Clinic Health System, Cleveland, OH. Dr. González Della Valle is Assistant Attending Orthopaedic Surgeon, Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY.

*The Implant Wear Symposium 2007 Clinical Work Group included John J. Callaghan, MD, John M. Cuckler, MD, Jorge O. Galante, MD, DMSc, Alejandro González Della Valle, MD, Stuart B. Goodman, MD, PhD, James I. Huddleston, MD, Lynne C. Jones, PhD, David G. Lewallen, MD, Henrik Malchau, MD, PhD, William Maloney, MD, Amanda Marshall, MD, Wayne Paprosky, MD, Hollis G. Potter, MD, Michael D. Ries, MD, Aaron Rosenberg, MD, Thomas P. Sculco, MD, Bernard N. Stulberg, MD, Audrey K. Tsao, MD, and Timothy Wright, PhD.

Dr. Stulberg or a member of his immediate family has received research or institutional support from Stryker, and is a consultant to or an employee of Styker and Exactech. Neither Dr. González Della Valle nor a member of his immediate family has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.

Periprosthetic osteolysis is most often diagnosed by plain radiographs. Because these radiographs routinely underestimate the extent of the lesion, three-dimensional imaging should be used early in the evaluation process to confirm the presenting extent of disease. If the osteolytic process is asymptomatic, scheduled regular follow-up should be instituted until the lesion can be confirmed to be stable or until the decision is made to proceed with surgery. Nonsurgical management with pharmacologic agents has not proved to be effective. If surgery is contemplated, a three-dimensional evaluation with magnetic resonance imaging or helical computed tomography can assist in preoperative planning. Surgical intervention requires complete débridement of the lesional membrane and removal of the wear-generator—with or without component removal and with or without bone grafting, depending on the individual circumstances. A standardized follow-up evaluation mechanism for all patients should be a part of total joint arthroplasty management.