Management of osteolysis around total hip arthroplasty.

The indications for treatment of osteolysis are based on osteolysis severity and progression. At present, there is a trend toward selective retention of well-fixed, undamaged components of satisfactory design, but long-term results of limited procedures with component retention for osteolysis are lacking. An algorithm for treatment of osteolysis around THA can be constructed. Such algorithms can help guide treatment, although it is important to note that judgment is still needed about the optimal treatment for each individual case. Regular follow-up of joint arthroplasty patients-especially those who are young and active and those with problematic implant designs--is important to identify osteolysis early and facilitate more limited intervention. There is increased understanding that osteolysis is a progressive process in the great majority of cases, and thus, most surgeons tend to consider intervention earlier than once was the case. Plain radiographs frequently underestimate the severity of osteolysis, particularly in the pelvis and greater trochanter, and metallic implants can obscure bone loss on routine radiographs. Therefore, when operative treatment is undertaken, the surgeon must be prepared for more severe bone loss than is visible on plain radiographs.