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Progression of Periacetabular Osteolytic Lesions
Donald W. Howie, MBBS, PhD, FRACS1; Susan D. Neale, MSc1; William Martin, FRCS2; Kerry Costi, BA1; Timothy Kane, FRCS3; Roumen Stamenkov, MD1; David M. Findlay, PhD4
1 Department of Orthopaedics and Trauma, Level 4, Bice Building, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia. E-mail address for S.D. Neale: susan.neale@health.sa.gov.au
2 Department of Trauma and Orthopaedics, Broomfield Hospital, Court Road, Chelmsford, Essex CM17ET, United Kingdom
3 Department of Orthopaedics, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth, Hampshire P063LY, United Kingdom
4 Discipline of Orthopaedics and Trauma, University of Adelaide, North Terrace, Adelaide, 5005, Australia
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Investigation performed at the Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia

Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Aug 15;94(16):e117 1-6. doi: 10.2106/JBJS.K.00877
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The development of three-dimensional computed tomography (CT) imaging techniques has enabled the detection, accurate measurement, and monitoring of periprosthetic osteolytic lesions. The aim of this study was to track the progression in size of osteolytic lesions and to determine those factors that are associated with the risk of progression. A secondary aim was to investigate whether progression in size of osteolytic lesions could be monitored with use of radiographs.


We retrospectively determined, with use of sequential CT scans, the progression of periacetabular osteolysis over a period of as much as nine years in a cohort of twenty-six patients (thirty acetabular components) in whom the cementless acetabular component or components had been in place for longer than ten years at the time of the initial CT scan. High-resolution CT scans with metal-artifact suppression were used to determine the volume of osteolytic lesions. Progression in the size of osteolytic lesions per year was calculated as the change in the volume of osteolytic lesions between serial CT scans. Associations were determined between the progression in size of osteolytic lesions, osteolysis rate at the initial CT, patient age, sex, walking limitations, and activity level. Progression in size of osteolytic lesions as determined with use of CT was compared with that determined with use of radiographs.


Mean progression in the size of osteolytic lesions, as determined with use of CT, was 1.5 cm3/yr (range, 0 to 7.5 cm3/yr). The amount of osteolysis at the initial CT scan and patient activity were good predictors of osteolytic lesion progression. The strongest predictor of osteolytic lesion progression occurred when these two risk factors were combined (p = 0.0019). The value of radiographs was limited to monitoring of larger lesions identified by CT.


This is the first study to report on the progression of osteolysis adjacent to cementless acetabular components from medium to long-term follow-up. The data suggest that the osteolysis rate at the initial CT and patient activity can be useful factors in predicting the progression in size of periacetabular osteolytic lesions.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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