(v) Silent osteolysis associated with an uncemented acetabular component: A monitoring and treatment algorithm

The rate of polyethylene wear is correlated with the occurrence of osteolysis and the survival of joint prostheses. Several types of metal-backed uncemented acetabular components are associated with a rather high polyethylene wear rate. Silent, asymptomatic cavitational osteolysis can progress into segmental osteolysis that may become manifest and preclude revision procedures. Therefore close monitoring is recommended if silent osteolysis is suspected. A helical CT scan should be performed when signs of osteolysis or evident polyethylene wear are observed on conventional radiographs, or if it concerns a type of metal-backed acetabular component associated with a documented high wear rate. When a cavitational lesion is observed a helical CT scan should be performed yearly and treatment with bisphosphonates is to be considered. In case of segmental osteolysis or progression of a cavitational lesion, extensive debridement of the osteolytic cysts, bone grafting and replacement of the polyethylene liner is the treatment of choice.