Hip replacement periacetabular osteolysis

Case contributed by Dr David Pryde

Presentation

Total hip replacement surveillance.

Patient Data

Age: 70 years
Gender: Male

X-ray  showing lytic area medial wall right acetabulum adjacent to the acetabular cup of a total hip replacement. ?osteolysis  ?neoplasia.

Sent for CT

CT confirms the radiographic finding or a periacetabular lytic lesion, with lysis of the inner cortex and a small bulging soft tissue component.

Case Discussion

Orthopaedic assessment was made with benign findings on biopsy by the surgeon.

His letter states:

" The diagnosis is one of periacetabular lysis, without there being any evidence of malignancy. As such I have recommended to the patient that we simply keep an eye on things. There is no loosening of his cup that requires any surgical intervention for now. The progression of the radiolucency has been quite slow and it is out of the weight-bearing portion of the acetabular component. We would like to keep an eye on it just to make sure that it is not progressing rapidly. As I mentioned in my previous letter, should the lysis increase to where failure of the cup is likely, then it is often better to intervene beforehand. I have recommended review in a year's time when he will have another set of x-rays taken ".

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Case information

rID: 39285
Case created: 30th Aug 2015
Last edited: 8th Aug 2016
Inclusion in quiz mode: Included

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