Hip Pelvis.  2016 Mar;28(1):1-14. 10.5371/hp.2016.28.1.1.

Acetabular Reconstruction in Total Hip Arthroplasty

Affiliations
  • 1Department of Orthopedic Surgery, Korea University Guro Hospital, Seoul, Korea. shonwy@hotmail.com

Abstract

The difficulties encountered in dealing with the bone deficient acetabulum are amongst the greatest challenges in hip surgery. Acetabular reconstruction in revision total hip arthroplasty can successfully be achieved with hemispherical components featuring a porous or roughened ingrowth surface and options for placement of multiple screws for minor acetabular defect. Acetabular component selection is mostly based on the amount of bone loss present. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been one of preferred surgical options. The use of a cage or ring over structural allograft bone for massive uncontained defects in acetabular revision can restore host bone stock and facilitate subsequent rerevision surgery to a certain extent. But high complication rates have been reported including aseptic loosening, infection, dislocation and metal failure. On the other hand, recent literature is reporting satisfactory outcomes with the use of modular augments combined with a hemispherical shell for major acetabular defect. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimizing biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. This article summarizes author's experience regarding revision acetabular reconstruction options following failed hip surgery including arthroplasty.

Keyword

Total hip arthroplasty; Acetabular reconstruction; Revision; Allograft

MeSH Terms

Acetabulum*
Allografts
Arthroplasty
Arthroplasty, Replacement, Hip*
Dislocations
Friction
Hand
Hip
Metals
Porosity
Metals

Figure

  • Fig. 1 (A, B) Radiograph and computed tomography (CT) scan respectively showing intra-pelvic acetabular protrusion with screw. (C) This patient sustained injury to the external iliac artery during acetabular component retrieval which is seen in the CT angiogram image.

  • Fig. 2 (A) Radiograph showing lysis around acetabular and femoral component. (B) Radiograph taken after revision with cementless acetabular and femoral components. (C) Follow up radiograph at 2 years showing loosening of acetabular component.

  • Fig. 3 (A) Radiograph showing severe cavitary defect in the right acetabulam. (B) Follow up radiograph at one year after revision done using impaction bone grafting and cementless acetabular cup. (C) Follow up radiograph at 3 years showing superior migration of cementless acetabular cup with resorption of the allograft.

  • Fig. 4 (A) Radiograph showing a failed bipolar tumor prosthesis with a severe superior acetabular defect. (B) Radiograph taken after revision with structural allograft and a cementless acetabular cup. (C) Computed tomography scan image showing well incorporated graft, 6 years after revision surgery. (D) Radiograph taken at 8 years after revision surgery showing well-functioning implants with no evidence of loosening.

  • Fig. 5 (A, B) Computed tomography (CT) scan images showing severe bone defect in the postero-superior column of acetabulam. (C) Radiograph taken after revision with structural allograft and anti-protrusio cage. (D) CT scan image done after 1 year showing a good fixation of cage between host bone and structural allograft.

  • Fig. 6 (A) Radiograph showing lysis and loosening of the anti-protrusio cage. (B) Post-operative radiograph done after revision with structural allograft and a cementless acetabular cup. (C) Follow up radiograph at 4 years, showing loosening of the acetabular cup. (D) Post-operative radiograph taken after revision with tantalum metal block and cementless acetabular cup.

  • Fig. 7 (A, B) Radiograph and computed tomography respectively showing failure of Kerboull plate because of fracture of screw at 11 years after operation. (C) Post-operative radiograph after revision with metal augment.

  • Fig. 8 (A) Radiograph showing superior and medial migration of bipolar prosthesis. (B) Radiograph taken after revision with impaction bone grafting and anti-protrusio cage. (C) Follow up radiograph at 10 years showing a well organised graft with no evidence of implant loosening.

  • Fig. 9 (A) Radiograph showing supero-medial migration of acetabular component. (B) Follow up radiograph at 1 year postoperaion showing no resorption of allograft and a good functioning anti-protrusio cage.

  • Fig. 10 (A, B, C) Computed tomography scan images showing postero-superior column defect in the acetabulam. (D) Postoperative radiograph done after revision with tantalum metal block and a cementless acetabular cup.

  • Fig. 11 (A) Computed tomography scan image showing pelvic discontinuity due to severe osteolysis. (B) Follow up radiograph at 6 years after revision with saddle prosthesis.


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