CEMENTED VERSUS CEMENTLESS FIXATION IN ASEPTIC LOOSENING OF TOTAL HIP ARTHROPLASTY: ASSOCIATION OF OSTEOLYSIS BURDEN WITH HARRIS HIP SCORE
Keywords:
Aseptic loosening, Total hip arthroplasty, Harris Hip Score, Osteolysis (bone resorption), Cemented and cementless fixationAbstract
Aseptic loosening remains a leading cause of revision total hip arthroplasty, where periprosthetic osteolysis and bone defects may substantially compromise hip function. The relationship between the burden and distribution of osteolysis and the Harris Hip Score (HHS), particularly when comparing cemented and cementless fixation, is not fully clarified. This retrospective study included 60 patients who underwent revision total hip arthroplasty for aseptic loosening, divided into 30 cemented and 30 cementless implants. Demographic data, body mass index, HHS, Paprosky acetabular defect type, osteolysis volume at the acetabular and femoral sides, and osteolysis distribution according to Gruen femoral zones and DeLee and Charnley acetabular zones were analyzed. Defect types were treated as ordinal categories, and correlations between HHS and osteolysis volume were evaluated separately for cemented and cementless implants. Differences in HHS according to defect type and zonal involvement were also assessed. In both groups, HHS decreased with increasing Paprosky defect severity, with a stronger association in cemented implants. In cemented hips, lower HHS was significantly associated with greater acetabular osteolysis volume, higher total osteolysis volume, and broader DeLee and Charnley zone involvement. In cementless hips, HHS was more strongly related to femoral and total osteolysis volume, while acetabular osteolysis and acetabular zonal distribution showed weaker and less consistent associations. In revision total hip arthroplasty for aseptic loosening, preoperative hip function assessed by HHS is closely related to the severity, volume, and anatomical distribution of osteolysis, with different patterns observed between cemented and cementless fixation. These findings suggest that osteolysis burden, beyond the mere presence of loosening, should be considered in preoperative assessment and planning of revision strategies.
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