RADIOLOGICAL CHARACTERISTICS OF OSTEOLYSIS IN CEMENTED VS. CEMENTLESS TOTAL HIP ARTHROPLASTY: A COMPARATIVE STUDY OF OSTEOLYTIC PATTERNS

Darko Talevski; Dushko Ciriviri; Jasmin Ciriviri; Jasminka Nancheva; Zoran Nestorovski; Toshe Vraniskoski; Nenad Atanasov; Zorica Vangelovska; Nenad Petkov

Darko Talevski City General Hospital " September 8 th" - Skopje
Dushko Ciriviri General City Hospital "September 8th", Skopje, North Macedonia
Jasmin Ciriviri University Clinic for Traumatology, Orthopedic Diseases, Anesthesia, Reanimation, Intensive Care and Emergency Centre, Skopje, North Macedonia
Jasminka Nancheva General City Hospital "September 8th", Skopje, North Macedonia
Zoran Nestorovski University Clinic for Traumatology, Orthopedic Diseases, Anesthesia, Reanimation, Intensive Care and Emergency Centre, Skopje, North Macedonia
Toshe Vraniskoski University Clinic for Traumatology, Orthopedic Diseases, Anesthesia, Reanimation, Intensive Care and Emergency Centre, Skopje, North Macedonia
Nenad Atanasov University Clinic for Traumatology, Orthopedic Diseases, Anesthesia, Reanimation, Intensive Care and Emergency Centre, Skopje, North Macedonia
Zorica Vangelovska University Clinic for Traumatology, Orthopedic Diseases, Anesthesia, Reanimation, Intensive Care and Emergency Centre, Skopje, North Macedonia
Nenad Petkov University Clinic for Traumatology, Orthopedic Diseases, Anesthesia, Reanimation, Intensive Care and Emergency Centre, Skopje, North Macedonia

Abstract

Background: Even though THA is a highly effective surgical procedure, its long-term success is frequently compromised by periprosthetic osteolysis and subsequent aseptic loosening of the implant. This study aims to: 1) compare the radiological features of osteolysis in cemented versus cementless THA, 2) locate the osteolytic zones using standard X-rays and 3) calculate the precise volume of these lesions using advanced CT scans. Methods: This is a comparative retrospective analysis of prospectively collected imaging data with primary concern on providing important information about the radiological patterns of osteolysis using objective and quantitative ways to measure the severity and the progression related to the fixation method (cemented vs. cementless). Osteolytic lesions were identified and quantified according to the Gruen zones on the femoral side and the DeLee and Charnley classification on the acetabular side, with volumetric CT-based measurements used to characterize patterns of bone degradation. Results: In this comparative analysis of 60 revised total hip arthroplasties, we found that cementless implants exhibited a distinctly more aggressive osteolytic phenotype than cemented implants, despite being in situ for markedly shorter durations. Cemented THA were revised later (median 20 vs 13 years) and predominantly in older patients, yet demonstrated substantially lower volumetric osteolysis across both the femoral and acetabular sides. Cementless hips showed nearly threefold greater total osteolytic burden (median 72.8 vs 23.9 cm³), with disproportionately high involvement of proximal femoral Gruen zones (1–3) and the superolateral acetabular zone (DeLee–Charnley zone 1). Conversely, cemented constructs exhibited relatively greater osteolytic involvement in distal femoral zones, consistent with endosteal cement–bone interface remodeling. Scatterplot analyses reinforced these patterns: cementless components accumulated significantly larger osteolytic volumes earlier in their lifespan, indicating a fundamentally different—and more rapid—biologic response to wear and fixation type. Conclusion: These findings suggest that fixation method exerts a powerful influence on the magnitude, tempo, and topographic distribution of osteolysis, with important implications for surveillance strategies, implant selection, and revision planning.

Keywords: Total hip arthroplasty; Cemented hip prosthesis; Cementless hip prosthesis; Periprosthetic osteolysis; Polyethylene wear; Computed tomography; Volumetric imaging; 3D Slicer.

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