Cost-effectiveness of early surgical intervention in silent osteolysis.

Access to subspecialty care is the subject of significant controversy. Most managed-care systems closely monitor the number of specialist referrals as well as x-rays ordered for patients with no symptoms, but large lytic lesions can exist around implants without any pain. Intervention costs were calculated for 2 groups of patients: 1 group with silent lysis with no symptoms and another group with periprosthetic fractures around lytic lesions. The costs were significantly higher in the group in which the fractures occurred versus the group in which early intervention was performed. Early diagnosis of structurally critical lytic lesions around implants by routine follow-up monitoring is recommended for all joint replacement patients.