Abstract
INTRODUCTION
Progressive polyethylene wear is associated with the occurrence of osteolysis, which can lead to component loosening and subsequent revision. Massive wear of the polyethylene liner may result in the penetration of the femoral head through the metal shell. Although metallosis after total hip arthroplasty has been well documented in the literature, extensive metallosis with polyethylene wear-through has been only sparsely described. The purpose of the present study was to assess clinical findings and the results of revision total hip arthroplasty in these cases.
METHODS
We evaluated seven hips in five patients who underwent revision total hip arthroplasty because of metallosis with polyethylene wear-through. The average age of the patients at the time of hip revision was 70.1 years. There were granulomatous cysts surrounding the hip joint and osteolysis in the greater trochanter or in the acetabulum. Eroded metal shells with worn-through polyethylene were exchanged. Kerboull-type acetabular reinforcement device were used in five hips and GAP cup in two. Distal interlocking femoral stems were used in four hips and extensively porous-coated stems in two. All cases with osteolysis were in addition treated with bulk or morselized allograft bone. The mean duration of follow-up was 3 years.
RESULTS
At the time of final follow-up evaluation, none of the hips showed osteolysis. Stable fixation of femoral and acetabular components was achieved in all cases. Bulk allograft bone was resorbed in two cases, but in all other cases grafted bones were united and improve bone stock.
CONCLUSIONS
Metallosis with polyethylene wear-through caused severe synovitis and massive osteolysis. Although debridement of the surrounding metallic stained tissue could not be completely done, the clinical result of revision surgery was favorable.
