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Progression of Acetabular Periprosthetic Osteolytic Lesions Measured with Computed Tomography
Donald W. Howie, MBBS, PhD, FRACS1; Susan D. Neale, MSc1; Roumen Stamenkov, MD1; Margaret A. McGee, BSc, MPH1; David J. Taylor, MBBS2; David M. Findlay, MSc, PhD1
1 Department of Orthopaedics and Trauma, Level 4, Bice Building, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia. E-mail address for S. Neale: susan.neale@health.sa.gov.au
2 Department of Radiology, Level 3, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Health and Medical Research Council, Novartis Pharmaceuticals, Royal Adelaide Hospital, and Bristol-Myers Squibb/Zimmer. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Novartis Pharmaceuticals Australia Pty Ltd and Bristol-Myers Squibb/Zimmer) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.
Investigation performed at the Department of Orthopaedics and Trauma and the Department of Radiology, Royal Adelaide Hospital, and the Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, Australia

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2007 Aug 01;89(8):1818-1825. doi: 10.2106/JBJS.E.01305
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Background: A better understanding of the factors associated with the size and/or progression of osteolytic lesions has been hampered by a lack of sensitivity of radiographic measurement techniques.

Methods: We retrospectively analyzed quantitative computed tomography scans that had been made with use of a high-resolution multi-slice scanner with a metal artifact-suppression protocol. The scans had been made to determine the volume of osteolytic lesions around thirty-five cementless Harris-Galante acetabular components that had been in situ for at least ten years. Repeat scans of thirty hips allowed for the measurement of progression in the size of osteolytic lesions over a one-year period. Associations between the volume of osteolytic lesions, progression in the size of the lesions, polyethylene wear since the time of implantation, change in component position, and patient-related variables (age, gender, body mass index, activity level, walking limitations, joint pain, and function) were determined.

Results: In sixteen of the thirty hips that had repeat computed tomography scans, the lesions progressed in size during the study period. The median size of the lesions in these sixteen hips was 10.3 cm3 at the time of the initial scan, compared with 13.3 cm3 at a median of fifteen months later (p = 0.001). Osteolytic lesions measuring >10 cm3 in volume on the initial scan were 2.5 times (95% confidence interval 1.3 to 4.8 times) more likely to progress in size over one year than smaller lesions were. Patients with greater polyethylene wear rates, higher activity levels, no walking limitations, and larger prosthetic femoral head dimensions (26 or 28 mm) had significantly larger osteolytic lesions (p < 0.0001, p = 0.009, p = 0.006, and p = 0.028, respectively). Progression in the size of the osteolytic lesions over one year was significantly associated with larger initial osteolytic lesions (p = 0.002), greater polyethylene wear rates (p = 0.009), and larger (26 or 28-mm) prosthetic femoral head dimensions (p = 0.019).

Conclusions: There is considerable variation in the rates of progression of the size of osteolytic lesions around stable acetabular components. Lesion size and the progression of lesion size are generally related to polyethylene wear rates, higher patient activity levels, and larger-diameter femoral heads. Osteolytic lesions measuring >10 cm3 in volume are associated with a high rate of progression.

Level of Evidence: Prognostic Level III. See Instructions to 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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