Escolar Documentos
Profissional Documentos
Cultura Documentos
Dr Raja Chaftari
Dr Tony Tannoury
Parvizi’s Case
Conflict of Interest
Research support:
NIH
OREF
DOD Consultant for:
Aircast Stryker Orthopaedics
MTF
Stryker Orthopaedics
Pfizer Intellectual Property:
The Knee Society Smartech
Kimberly Clark Smith and Nephew
Ortho McNeill
Stryker Orthopeadics
Adolor
Cubist CyruMed
3M
KCI
COMPLEX INTERPLAY
POLYETHYLENE
WEAR
CLINICAL OSTEOLYSIS
SYMPTOMS
INDIVIDUAL RESPONSE TO
WEAR DEBRIS
Bone Loss Around THA
Preoperative work up
Treatment options
Surgical Execution
What is the Best Method to Evaluate
Polyethylene Wear?
Determine the Remaining
Liner Thickness
Repeat X-Ray at Optimal kV
Setting for the Pelvis
64 kV 84 kV
Retroacetabular
Stress Shielding
Or
Ostolysis
Immediate postop 1 yr postop
Immediate postop 10 yrs postop
Immediate postop 11years postop
Radiographs
underestimate
Osteolysis
Immediate postop 9 years postop
What is the Value of CT in
Management of Osteolysis?
-Can quantitate polyethylene thickness
-Can detect ischial and posterior rim
osteolysis
- Can detect cortical erosions (size of
break in medial cortical wall)
- Can quantitate volume of osteolysis
- Can quantitate cup support
8 yrs postop
Volume Measurements of Osteolysis
28.7 cm3
Quantification of Cup Support
Polyethylene Thickness
Measurements
Minimum Thickness
1.9 mm
Bone Loss Around THA
Preoperative work up
Treatment options
Surgical Execution
CHOICES FOR
INTERVENTION
OBSERVATION
MEDICATION
OPERATION
OBSERVATION
KEEP AN EYE ON IT
DOCUMENT PROGRESSION
KEEP AN EYE ON IT
WAIT FOR
PAIN
TO DEVELOP
DOCUMENT PROGRESSION
FOSAMAX
MUTING RESPONSE
NOT SOLVING THE PROBLEM
OPERATION
TIMING
CHOICE OF
PROCEDURE
STAGING ACETABULAR
OSTEOLYSIS
I WEAR ONLY
IIA WEAR AND PAIN, NO LYSIS SEEN
IIB WEAR AND LYSIS, NO PAIN
III WEAR AND LYSIS AND PAIN
STAGE I
WEAR ONLY
STAGE IIA
SOCKET LOOSE
REVISE CUP
Bone Loss Around THA
Preoperative work up
Treatment options
Surgical Execution
ACETABULAR REVISION
Treatment Options:
Cemented sockets
Bipolar
Antiprotrusio devices
Acetabular Classification
• Type I - Cavitary
• Type II - Segmental
• Type III - Combined
• Type IV - Pelvic Discontinuity
Cavitary
Segmental
CM 05/25/00
Discontinuity
Is Component Loose?
NO YES
Use Cementless
Cup
What Bone Graft is needed?
Structural Supplemental
Cementless Cup
Cemented Cup
Cage
Surgery for Pelvic Osteolysis
95%
Contra-indications
• Pelvic discontinuity
• Post-irradiation
• <50% host bone
in contact with cup
<5%
ACETABULAR REVISION
Uncemented Sockets
6/25/2010
6/25/2010
6/25/2010
6/25/2010
6/25/2010
6/25/2010
6/25/2010
6/25/2010
Summary
Bone Loss
- Requires careful radiographic follow-
up
- CTs can help in decision making
- The algorithm for management of
osteolysis is evolving
Thank You