Management of Bone Loss during Revision of Hip Arthroplasty

Abstract

The main factors adversely affecting maintenance of bone mass after THA: (1) bone loss secondary to particulate debris which is the most frequent cause of significant focal cortical bone resorption; (2) adaptive bone remodeling and stress shielding secondary to size, material properties, and surface characteristics of contemporary prostheses; and (3) bone loss as a consequence of natural agmg. Many classification systems have been described over the last years for bone loss that is found in association with the failed hip arthroplasty. Most are based on assessments of bone stock that are made intraoperatively. Good-quality plain radio ,rraphy useful preoperative investigation and provides important information regarding the residual bone stock. Revision of total hip arthroplasty usually is much more difficult and the results definitely are not as satisfactory as after a primary total hip arthroplasty. Revision requires more operative time, more blood is lost, and the incidences of infection, thromboembolism, dislocation, nerve palsy, and penetration and fracture of the femur are higher. The appropriate surgical exposure for any revision procedure should be determined by careful preoperative planning based on an assessment of the implant type to be removed; extent of bone deficiencies to be reconstructed; and, if possible, knowledge of the previous exposures used. Osteotomies and soft tissue incisions should •be adequate and avoid uncontrolled bone and soft tissue disruption.