Isolated Liner Exchange and Bone Grafting for the Management of Periacetabular Osteolysis in Well-Fixed Cups with an Intact Locking Mechanism at Short-Term to Medium-Term Follow-Up: A Systematic Review

Robert G Ricotti; Michael Alexander-Malahias; Qian-Li Ma; Seong J Jang; Rafael Loucas; Ioannis Gkiatas; Philip P Manolopoulos; Alex Gu; Danilo Togninalli; Vasileios S Nikolaou; Peter K Sculco

doi:10.1177/15563316231189736

Isolated Liner Exchange and Bone Grafting for the Management of Periacetabular Osteolysis in Well-Fixed Cups with an Intact Locking Mechanism at Short-Term to Medium-Term Follow-Up: A Systematic Review

HSS J. 2024 Nov;20(4):567-576. doi: 10.1177/15563316231189736. Epub 2023 Sep 7.

Authors

Affiliations

¹ The Stavros Niarchos Foundation Complex Joint Reconstruction Center, Hospital for Special Surgery, New York, NY, USA.
² School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA.
³ Department of Orthopedic Surgery, Fuzhou Second Hospital, Xiamen University, Fuzhou, China.
⁴ Weill Cornell Medical College, New York, NY, USA.
⁵ Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
⁶ Department of Orthopedics and Traumatology, Clinica ARS Medica, Gravesano, Switzerland.
⁷ 2nd Orthopaedic Department, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.

PMID: 39494435
PMCID: PMC11528827 (available on 2025-11-01)
DOI: 10.1177/15563316231189736

Abstract

Background: Polyethylene liner exchange and bone grafting is an effective surgical option for the management of periacetabular osteolysis following total hip arthroplasty with well-fixed cups and intact liner locking mechanisms. Purpose: We aimed to evaluate the revision-free survivorship and radiographic lesion progression after polyethylene liner exchange and bone grafting is performed for periacetabular osteolysis. Methods: A systematic review of the literature was performed. We queried Medline, EMBASE, and Cochrane Library for articles published from January 1999 to January 2023 using the following keywords: "osteolysis" AND "well-fixed," "osteolysis" AND "retro-acetabular," "bone graft" AND ("retention" OR "retained" OR "stable") AND "cup," and "uncemented liner" AND "well-fixed." Results: Of 596 articles found, 9 articles were selected for final inclusion (227 cases, mean follow-up time 43.6 months). The overall cup revision rate after liner exchange was 6.6% (15 hips) due to progressive osteolysis (5 hips), aseptic loosening of the acetabular component (5 hips), dislocation (4 hips), and periprosthetic infection (1 hip). There was either radiographic resolution or regression of periacetabular osteolysis in all reported cases that provided measurements (52 hips) except 1 (1.9%) requiring revision. All studies reporting clinical outcomes indicated improved pain and functional scores. Conclusion: This systematic review found that isolated liner exchange with bone grafting for the management of periacetabular osteolysis was associated with a high revision-free survival rate (93.4%) and minimal radiographic progression (1.9%) of osteolytic lesions at short-term to medium-term follow-up. Liner exchange with bone grafting is recommended for the management of large periacetabular osteolytic lesions (> 450 mm²) in well-fixed acetabular cups. We encourage future studies to develop a grading scale for lesions to guide clinical management and risk stratification for patients.

Keywords: hip arthroplasty; liner; osteolysis; systematic review; well-fixed cup.

Publication types

Review