Unpredictable progression of osteolysis following cementless hip arthroplasty. 24 femoral components followed for 6-10 years.

We reviewed 24 hips that developed femoral osteolytic lesions following cementless total hip replacement with a Porous-Coated Anatomic prosthesis after a mean of 8 (6-10) years. 15 of the hips showed hardly any radiographic deterioration in the osteolysis. 2 became much worse with dramatic loss of bone stock. Both of these hips required revision of the acetabular component as well as bone grafting of the otherwise well-fixed femoral component. The remaining 7 hips showed mild-to-moderate enlargement of the lesions. All 24 hips were asymptomatic. Blood tests and bone scintigraphy were of no predictive value in assessing the probable progression of the lesions. Serial radiography remains the cornerstone of the monitoring of osteolysis, following cementless hip replacement, the extent of bone loss being usually far greater than indicated by radiographic examination.