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Age and Gender are Significant Risk Factors for Osteolysis after Total Hip Arthroplasty

Patients under the age of 65 years and men in general have a higher risk of developing osteolysis after total hip arthroplasty, according to a recent American study.

One predominant long-term problem with total hip arthroplasty is osteolysis, which results from implant wearing and makes revision surgery more technically difficult. Osteolysis can progress asymptomatically or painfully, and there is increasing controversy as to whether intervention is necessary for asymptomatic osteolysis.

An understanding of the factors that increase the risk of osteolysis is necessary in order for appropriate and early intervention to be implemented.

Ohannes A. Nercessian, MD, and colleagues at the New York Orthopedic Hospital, New York, United States, evaluated the influence of demographic and technical variables on the development of osteolysis after Charnley primary low-friction arthroplasty.

The study included 633 hips from 494 patients (301 women, average age 58) who underwent primary total hip arthroplasty from 1970 to 1985, under the same surgeon. Radiographic evaluation of osteolysis was conducted by three independent reviewers at 3 months, 6 months, 1 year and annually thereafter.

Demographic variables considered included age, gender, diagnosis, and Charnley joint class, and technical variables analysed included design of acetabular and femoral components, subchondral plate retention versus removal, and cementing techniques.

Radiographic evaluation indicated that the incidence of osteolysis increased with time, from 2% at 5 years to 17% at 20 years. Moreover, it was also determined that osteolysis occurred earlier than loosening and failure.

Further analysis revealed that age and gender were the only variables that affected the incidence of osteolysis.

The authors note that "many of the 'improvements' in prosthesis design and the technical aspects of total hip arthroplasty did not significantly decrease the incidence of osteolysis."

In addition, none of the variables tested in this analysis increased the risk of avascular necrosis of the femoral head, developmental dysplasia of the hip, inflammatory arthritis, or osteoarthritis.

Dr. Nercessian concludes that "the study identified young age (less than 65 years) and male gender as risk factors for the development of osteolysis." He further notes that "it is perhaps critical to observe these patients more closely, given the increased likelihood of the need for revision surgery with a longer life expectancy from the time of onset of osteolysis."

Overall, Dr. Nercessian highlights that "regular assessment with the goal of earlier identification, especially in higher risk younger and male patients, is important to avoid excessive bone loss and technical difficulties in revision surgery."




J Arthroplasty 2003 Aug;18:5:631-7. "Influence of demographic and technical variables on the incidence of osteolysis in charnley primary low-friction hip arthroplasty"

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