Options for Managing Severe Acetabular Bone Loss in Revision Hip Arthroplasty. a Systematic Review

Abstract

Revision hip arthroplasty in the presence of severe acetabular bone loss is challenging and requires a solid understanding of current techniques. A literature search of multiple databases applying specific criteria revealed a total of 50 articles of level IV scientific evidence comprising 2415 patients (2480 hips) managed with reinforcement devices (roof-reinforcement rings and anti-protrusio cages), custom-made triflanged acetabular components (CTACs), jumbo cups and tantalum metal (TM) systems. Overall, patients had improved postoperative hip scores for each technique. The use of reinforcement devices resulted in a mean revision rate of 8.2% and a mean complication rate of 29.21%. CTACs were associated with a revision rate of 15.9% and had a complication rate of 24.5%. Jumbo cups were revised in 8.8% of patients and had a complication rate of 18.4%. TM systems had an overall revision rate of 8.5% with complications seen in 18.5% of patients. CTACs had considerably higher revision rates compared to the other techniques. Jumbo cups and TM systems had lower complication rates compared to the use of reinforcement devices and CTACs. The most frequently occurring complications seen throughout the series were aseptic loosening, dislocation and infection.

Acetabular revision arthroplasty using trabecular titanium implants

“…A similar trend has also been observed for revision hip procedures [1]. Different materials, implant designs and sizes are available for THA acetabular revisions [2]. Special constructs are used for THA revision surgery with various success rates [3,4].…”

Intracavitary and Extracavitary Iliac Extended Fixation Using Porous Metal Augments for Paprosky Type 3 Acetabular Defects in Revision Total Hip Arthroplasty: A Minimum 2 Years Follow-up

“…The quality of the superior acetabular bone stock is critical to prosthetic acetabular component fixation and load transmission [29]. Unfortunately, superior acetabular bone defects are commonly encountered in revision total hip arthroplasty (THA) [14,16,26,34]. Paprosky type 3 defects indicate severe and extensive superior acetabular bone loss, often requiring reconstruction to be extended to an area at least 2 cm above the original acetabular rim [26].…”

“…Paprosky type 3 defects indicate severe and extensive superior acetabular bone loss, often requiring reconstruction to be extended to an area at least 2 cm above the original acetabular rim [26]. Several different methods exist as a means of reconstructing superior bone defects, including jumbo cups, structural allografts, cup-cage construction, and impaction bone graft with cemented cups [14,34]. Each method has been successful in selected cases.…”

Tritanium acetabular wedge augments: short-term results

“…There are numerous publications on how to manage various acetabular defects (2)(3)(4). Due to lack of resources, the initial treatment for these types of defects was structural allografts (5,6).…”