Osteolysis in the well-fixed socket: cup retention or revision?

Osteolysis remains a common reason for revision after total hip arthroplasty (THA). For osteolysis associated with loose cups, revision is indicated. For osteolysis around a well-fixed cup, the decision is more controversial. The data available data support retention of the cupwith lesional treatment, working through screw holes and access channels for debridement and grafting. The choice of graft material to fill defects, if any, remains controversial. Several studies demonstrate good survivorship with cup retention strategies. Complete revision allows more complete debridement of the lesion and better graft fill, and allows implantation of a modern cup, typically with a full line of liners and bearing surfaces available. Additionally, revision allows fine tuning of the orientation of the cup, which may be advantageous for optimising hip stability. The author prefers to retain a well-fixed cup if it meets the following criteria: it is well-fixed to intra-operative testing, it is well-positioned, it is of sufficient size to allow insertion of a new liner with a reasonable head size, new liners are available, and the hip is stable to intra-operative trialing after liner insertion.