Periprosthetic osteolysis after total hip replacement: molecular pathology and clinical management.

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Abstract

[Indexed for MEDLINE] 6. J Bone Joint Surg Am. 2025 Apr 16;107(8):e33. doi: 10.2106/JBJS.24.00580. Epub 2025 Feb 25. Outcomes of Autogenous Bone Grafting for Periprosthetic Osteolysis After Total Ankle Arthroplasty: Clinical and 3-Dimensional Computed Tomography Results. Yoon YK(1), Park KH(2), Shim DW(2), Lee W(2), Chae JS(3), Han SH(4), Lee JW(2). Author information: (1)Department of Orthopaedic Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea. (2)Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. (3)Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea. (4)Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea. BACKGROUND: Periprosthetic osteolysis after total ankle arthroplasty (TAA) is a substantial problem. Bone grafting may be beneficial in the treatment of large osteolytic cysts; however, the literature regarding the outcomes of bone grafting is limited. This study analyzed the outcomes of autogenous bone grafting performed for the management of periprosthetic osteolysis following TAA. METHODS: We retrospectively reviewed 42 ankles (41 Korean patients) that underwent autogenous bone grafting for periprosthetic osteolysis following TAA. Clinical outcomes were evaluated using visual analog scale for pain scores, Ankle Osteoarthritis Scale pain and disability scores, and American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale scores. Computed tomography (CT) was performed preoperatively and for at least 2 years postoperatively in order to evaluate the treatment response. Histology, prosthesis survivorship, reoperations, and complications were also evaluated. RESULTS: The mean time to autogenous bone grafting was 64.4 months (range, 10 to 128 months), and the mean follow-up duration after autogenous bone grafting was 70.7 months (range, 24 to 137 months). All clinical scores significantly improved from preoperatively to the last follow-up visit. The mean osteolytic cyst volume improved from 4.8 cm 3 (range, 1.1 to 19.4 cm 3 ) to 0.8 cm 3 (range, 0 to 6.5 cm 3 ). A Kaplan-Meier survival analysis revealed that TAA with subsequent bone grafting was associated with similar prosthesis survivorship (100% and 85.7% at 5 and 10 years, respectively) but inferior reoperation-free survivorship (93.4% and 68.4% at 5 and 10 years, respectively) compared with TAA without osteolysis or with non-progressive osteolysis. CONCLUSIONS: Autogenous bone grafting performed for the management of periprosthetic osteolysis after TAA produced favorable clinical and radiographic outcomes. However, there was still a higher risk of subsequent surgery even after successful bone grafting, compared with TAA without osteolysis or with non-progressive osteolysis. Our results suggest that autogenous bone grafting and serial CT scan monitoring over time may prolong the survivorship of TAA prostheses in ankles with periprosthetic osteolysis. LEVEL OF EVIDENCE: Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence. Copyright © 2025 by The Journal of Bone and Joint Surgery, Incorporated. DOI: 10.2106/JBJS.24.00580