eMedicine Specialties > Orthopedic Surgery > Hip

Acetabular Wear in Total Hip Arthroplasty: Workup

Author: Hari P Bezwada, MD, Staff Physician, Department of Orthopedic Surgery, Drexel University College of Medicine
Coauthor(s): David G Nazarian, MD, Assistant Clinical Professor, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Robert E Booth Jr, MD, Clinical Professor of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief, Department of Orthopedic Surgery, Pennsylvania Hospital
Contributor Information and Disclosures

Updated: Apr 15, 2009

Workup

Laboratory Studies

  • Laboratory evaluation prior to any surgical intervention should include complete blood cell counts, coagulation studies, and routine chemistries.
  • Erythrocyte sedimentation rate and C-reactive protein are useful, especially in excluding indolent infection.

Imaging Studies

  • Radiography
    • Standard anteroposterior (AP) hip and pelvis views and frog-leg lateral views are central to the evaluation of acetabular wear in total hip arthroplasty. Most information can be gathered from these views.
    • Serial radiography over time confers additional information regarding wear and prosthetic loosening.
    • In the setting of significant osteolysis, additional views may be helpful in defining the extent of these lesions and the extent of any bony deficiencies. They include Judet oblique views to evaluate the integrity of both the anterior and posterior columns and the false profile view and sitting lateral view.
  • Computed tomography scanning: This study may provide supplemental information regarding the pelvis and help differentiate contained bony deficiencies from significant pelvic discontinuity.

Other Tests

  • Nuclear scanning: Although bone scintigraphy has been available for more than 30 years, it plays a limited role in the evaluation of a painful hip prosthesis. The main determinants of technetium (Tc)–99m methylene diphosphate (Tc-99m MDP) tracer uptake in bone are blood flow and metabolic bone activity. Increased tracer uptake may be observed for 12-24 months following implantation of a total hip prosthesis because of bone remodeling. The appearance of abnormal uptake surrounding a painful prosthesis has been used to differentiate loosening from infection. Loose prostheses tend to show increased uptake in the trochanters, at the stem tip, and possibly the acetabular shell. Bone scintigraphy is sensitive for infection but lacks specificity.20
    • Gallium scanning may be useful in the assessment of infection. Gallium binds to serum transferrin and carries an accuracy of 75% in detecting a periprosthetic infection. It has more intense uptake than Tc-99m MDP, and combining these tests may be effective in the evaluation of a painful prosthesis.
    • Indium-labeled white cells accumulate in the region of infection because of chemotaxis. Mixed white cell lines are used in the preparation and may account for the similar sensitivity for acute and chronic infections of 82%.

Diagnostic Procedures

  • In cases in which infection is serious consideration, preoperative aspiration may also prove helpful in further evaluation.

More on Acetabular Wear in Total Hip Arthroplasty

Overview: Acetabular Wear in Total Hip Arthroplasty
Workup: Acetabular Wear in Total Hip Arthroplasty
Treatment: Acetabular Wear in Total Hip Arthroplasty
Follow-up: Acetabular Wear in Total Hip Arthroplasty
Multimedia: Acetabular Wear in Total Hip Arthroplasty
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Charnley J. Long-term results of low-friction arthroplasty. Hip. 1982;42-9. [Medline].

  2. Charnley J. Total hip replacement by low-friction arthroplasty. Clin Orthop Relat Res. Sep-Oct 1970;72:7-21. [Medline].

  3. Charnley J. Arthroplasty of the hip. A new operation. Lancet. May 27 1961;1(7187):1129-32. [Medline].

  4. Bhatt H, Goswami T. Implant wear mechanisms--basic approach. Biomed Mater. Dec 2008;3(4):42001. [Medline].

  5. Cipriano CA, Issack PS, Beksac B, Della Valle AG, Sculco TP, Salvati EA. Metallosis after metal-on-polyethylene total hip arthroplasty. Am J Orthop. Feb 2008;37(2):E18-25. [Medline].

  6. Schmalzried TP, Callaghan JJ. Wear in total hip and knee replacements. J Bone Joint Surg Am. Jan 1999;81(1):115-36. [Medline].

  7. Dorr LD, Wan Z, Longjohn DB, et al. Total hip arthroplasty with use of the Metasul metal-on-metal articulation. Four to seven-year results. J Bone Joint Surg Am. Jun 2000;82(6):789-98. [Medline].

  8. McKellop HA, Campbell P, Park SH, et al. The origin of submicron polyethylene wear debris in total hip arthroplasty. Clin Orthop. Feb 1995;(311):3-20. [Medline].

  9. McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB, Chess DG, Charron KD. Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. Apr 2009;91(4):773-82. [Medline].

  10. Schmalzried TP, Clarke IC, McKellop HA. Bearing surfaces. In: Callaghan JJ, Rosenberg AG, and Rubash HE, eds. The Adult Hip. Philadelphia, Pa:. Lippincott-Raven;1998:247-265.

  11. Sychterz CJ, Engh CA Jr, Yang A, Engh CA. Analysis of temporal wear patterns of porous-coated acetabular components: distinguishing between true wear and so-called bedding-in. J Bone Joint Surg Am. Jun 1999;81(6):821-30. [Medline].

  12. Sychterz CJ, Engh CA Jr, Young AM, et al. Comparison of in vivo wear between polyethylene liners articulating with ceramic and cobalt-chrome femoral heads. J Bone Joint Surg Br. Sep 2000;82(7):948-51. [Medline].

  13. Livermore J, Ilstrup D, Morrey B. Effect of femoral head size on wear of the polyethylene acetabular component. J Bone Joint Surg Am. Apr 1990;72(4):518-28. [Medline].

  14. Oonishi H, Kadoya Y, Masuda S. Gamma-irradiated cross-linked polyethylene in total hip replacements--analysis of retrieved sockets after long-term implantation. J Biomed Mater Res. 2001;58(2):167-71. [Medline].

  15. Charnley J. Postoperative infection after total hip replacement with special reference to air contamination in the operating room. Clin Orthop Relat Res. Sep 1972;87:167-87. [Medline].

  16. Harris WH, Schiller AL, Scholler JM, et al. Extensive localized bone resorption in the femur following total hip replacement. J Bone Joint Surg Am. Jul 1976;58(5):612-8. [Medline].

  17. Jasty MJ, Floyd WE 3rd, Schiller AL, et al. Localized osteolysis in stable, non-septic total hip replacement. J Bone Joint Surg Am. Jul 1986;68(6):912-9. [Medline].

  18. Anthony PP, Gie GA, Howie CR. Localised endosteal bone lysis in relation to the femoral components of cemented total hip arthroplasties. J Bone Joint Surg Br. Nov 1990;72(6):971-9. [Medline].

  19. Willert HG. Reactions of the articular capsule to wear products of artificial joint prostheses. J Biomed Mater Res. Mar 1977;11(2):157-64. [Medline].

  20. Merkel KD, Brown ML, Fitzgerald RH Jr. Sequential technetium-99m HMDP-gallium-67 citrate imaging for the evaluation of infection in the painful prosthesis. J Nucl Med. Sep 1986;27(9):1413-7. [Medline].

  21. Yang CC, Kim RH, Dennis DA. The squeaking hip: a cause for concern-disagrees. Orthopedics. Sep 2007;30(9):739-42. [Medline].

  22. Keurentjes JC, Kuipers RM, Wever DJ, Schreurs BW. High incidence of squeaking in THAs with alumina ceramic-on-ceramic bearings. Clin Orthop Relat Res. Jun 2008;466(6):1438-43. [Medline].

  23. Mary Ann Porucznik. What's making the noise in squeaky hips?. American Academy of Orthopaedic Surgeons. Available at http://www.aaos.org/news/bulletin/janfeb07/clinical6.asp. Accessed April15, 2009.

  24. Christensen CP, Jacobs C. 2009 Annual Meeting Podium PresentationsAdult Reconstruction Hip 3: Bearing Surfaces: Hard on Hard BearingsGreater Prevalence of Early Complications with Ceramic-on-Ceramic than with Metal-on-Metal THAs. American Academy of Orthopaedic Surgeons. Available at http://www3.aaos.org/education/anmeet/anmt2009/podium/podium.cfm?Pevent=196. Accessed April 15, 2009.

  25. Colwell CW Jr, Mai K, Verioti C, Ezzet KA, Copp S, Walker RH. 2009 Annual Meeting Podium PresentationsAdult Reconstruction Hip 3: Bearing Surfaces: Hard on Hard BearingsIncidence of Squeaking After Ceramic-on-Ceramic Total Hip Arthroplasty: 2 - 10 Year Follow-Up. American Academy of Orthopaedic Surgeons. Available at http://www3.aaos.org/education/anmeet/anmt2009/podium/podium.cfm?Pevent=201. Accessed April 15, 2009.

  26. Brockett CL, Harper P, Williams S, Isaac GH, Dwyer-Joyce RS, Jin Z, et al. The influence of clearance on friction, lubrication and squeaking in large diameter metal-on-metal hip replacements. J Mater Sci Mater Med. Apr 2008;19(4):1575-9. [Medline].

  27. Kim RH, Dennis DA, Carothers JT. Metal-on-metal total hip arthroplasty. J Arthroplasty. Oct 2008;23(7 Suppl):44-6. [Medline].

  28. Moroni A, Savarino L, Cadossi M, Baldini N, Giannini S. Does ion release differ between hip resurfacing and metal-on-metal THA?. Clin Orthop Relat Res. Mar 2008;466(3):700-7. [Medline].

  29. Passuti N, Terver S. [Metal on metal bearing surfaces in total hip arthroplasty: a survey of material incidents]. Rev Chir Orthop Reparatrice Appar Mot. May 2007;93(3):288-312. [Medline].

  30. Jacobsson SA, Djerf K, Wahlstrom O. A comparative study between McKee-Farrar and Charnley arthroplasty with long-term follow-up periods. J Arthroplasty. Mar 1990;5(1):9-14. [Medline].

  31. Jacobs JJ, Skipor AK, Patterson LM, et al. Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study. J Bone Joint Surg Am. Oct 1998;80(10):1447-58. [Medline].

  32. Visuri T, Pukkala E, Paavolainen P, et al. Cancer risk after metal on metal and polyethylene on metal total hip arthroplasty. Clin Orthop. Aug 1996;(329 Suppl):S280-9. [Medline].

  33. Lewis PM, Al-Belooshi A, Olsen M, Schemitch EH, Waddell JP. Prospective randomized trial comparing alumina ceramic-on-ceramic with ceramic-on-conventional polyethylene bearings in total hip arthroplasty. J Arthroplasty. Feb 4 2009;[Medline].

  34. Geerdink CH, Grimm B, Vencken W, Heyligers IC, Tonino AJ. Cross-linked compared with historical polyethylene in THA: an 8-year clinical study. Clin Orthop Relat Res. Apr 2009;467(4):979-84. [Medline].

  35. McCalden RW, MacDonald SJ, Rorabeck CH, Bourne RB, Chess DG, Charron KD. Wear rate of highly cross-linked polyethylene in total hip arthroplasty. A randomized controlled trial. J Bone Joint Surg Am. Apr 2009;91(4):773-82. [Medline].

  36. Jacobs CA, Christensen CP, Greenwald AS, McKellop H. Clinical performance of highly cross-linked polyethylenes in total hip arthroplasty. J Bone Joint Surg Am. Dec 2007;89(12):2779-86. [Medline].

  37. Wroblewski BM, Siney PD, Dowson D. Prospective clinical and joint simulator studies of a new total hip arthroplasty using alumina ceramic heads and cross-linked polyethylene cups. J Bone Joint Surg Br. Mar 1996;78(2):280-5. [Medline].

  38. Jacobs CA, Christensen CP, Greenwald AS, McKellop H. Clinical performance of highly cross-linked polyethylenes in total hip arthroplasty. J Bone Joint Surg Am. Dec 2007;89(12):2779-86. [Medline].

  39. Geerdink CH, Grimm B, Vencken W, Heyligers IC, Tonino AJ. Cross-linked compared with historical polyethylene in THA: an 8-year clinical study. Clin Orthop Relat Res. Apr 2009;467(4):979-84. [Medline].

  40. Charnley J. Total hip replacement. JAMA. Nov 18 1974;230(7):1025-8. [Medline].

  41. Charnley J, Halley DK. Rate of wear in total hip replacement. Clin Orthop Relat Res. Oct 1975;170-9. [Medline].

  42. Harris WH. Cross-linked polyethylene: why the enthusiasm?. Instr Course Lect. 2001;50:181-4. [Medline].

  43. McKellop HA. Wear assessment. In: Callaghan JJ, Rosenberg AG, Rubash HE, eds. The Adult Hip. Philadelphia, Pa:. Lippincott-Raven;1998:231-246.

  44. Schmalzried TP, Szuszczewicz ES, Northfield MR, et al. Quantitative assessment of walking activity after total hip or knee replacement. J Bone Joint Surg Am. Jan 1998;80(1):54-9. [Medline].

  45. Smith J, Crawford L. The Link Between Perceived Adequacy of Preparation to Practice, Nursing Error, and Perceived Difficulty of Entry-level Practice. JONAS Healthc Law Ethics Regul. Dec 2003;5(4):100-3. [Medline].

[ CLOSE WINDOW ]

Keywords

acetabular wear, total hip arthroplasty, low-friction total hip arthroplasty, THA, acetabular wear debris, fatigue, interfacial wear, backside wear, linear penetration, hip reconstruction, hip prosthesis, hip implant, hip replacement, osteolysis, prosthetic loosening, squeaking hip

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Hari P Bezwada, MD, Staff Physician, Department of Orthopedic Surgery, Drexel University College of Medicine
Hari P Bezwada, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and Pennsylvania Orthopaedic Society
Disclosure: Nothing to disclose.

Coauthor(s)

David G Nazarian, MD, Assistant Clinical Professor, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine
David G Nazarian, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

Robert E Booth Jr, MD, Clinical Professor of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief, Department of Orthopedic Surgery, Pennsylvania Hospital
Robert E Booth Jr, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Jegan Krishnan, MBBS, FRACS, PhD, Professor, Chair, Department of Orthopedic Surgery, Flinders University of South Australia; Senior Clinical Director of Orthopedic Surgery, Repatriation General Hospital; Private Practice, Orthopaedics SA, Ashford Specialist Centre
Jegan Krishnan, MBBS, FRACS, PhD is a member of the following medical societies: Australian Medical Association, Australian Orthopaedic Association, and Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

B Sonny Bal, MD, Associate Professor, Department of Orthopedic Surgery, University of Missouri School of Medicine
B Sonny Bal, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons
Disclosure: Nothing to disclose.

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Carlos J Lavernia, MD, FAAOS, Adjunct Clinical Professor, Department of Orthopedic Surgery, University of Miami School of Medicine; Medical Director, Orthopedic Institute at Mercy Hospital
Carlos J Lavernia, MD, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Hip and Knee Surgeons, Arthritis Foundation, Biomedical Engineering Society, Florida Orthopaedic Society, and Orthopaedic Research Society
Disclosure: Zimmer Stock Implant Designer

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.