Reconstruction options and outcomes for acetabular bone loss in revision hip arthroplasty

Abstract

Revision total hip arthroplasty in the setting of acetabular bone loss is a challenging procedure and requires a solid understanding of current acetabular reconstruction options. Despite major developments in the field of revision hip surgery in recent decades, reconstruction of acetabular defects remains a major problem in order to achieve primary stability and durable fixation without sacrificing additional bone stock. Although there are several ways to classify acetabular bone defects, the Paprosky classification system is the most commonly used to describe the defects and guide treatment strategy. An understanding of the bone defects associated with detailed pre-operative assessment and planning are essential elements in order to achieve satisfactory outcomes. Multiple acetabular reconstructive options are currently available including impaction bone grafting with metal mesh, reinforcement rings and antiprotrusio cage, structural allografts, cementless hemispherical cups, extra-large “jumbo cups”, oblong cups, modular porous metal augments, cup-cage constructs, custom- made triflange cups, and acetabular distraction. To date, debate continues as to which technique is most effective due to the lack of long-term studies of modern reconstruction systems. Further long-term studies are necessary to assess the longevity of the different implants. The purpose of this study was to review the current literature and provide a comprehensive understanding of the available reconstruction options with their clinical outcomes.

Extensive type IIIB bone loss of the acetabulum and suitability of 3D printings during planning

“…Preparations for the next step lasted three months. Several possible solutions were considered [7]: 1. Structural allograft from the femoral head to restore the acetabular roof.…”

“…Once initiated, the processes of the immune response lead to the loosening and migration of the implant, destruction of the bone tissue around it, and ultimately to worsening discomfort, pain and gait failure of the patient [4,5]. Acetabular and femoral defects are classified according to the commonly accepted Paprosky classification and vary from the minor (type I) to extensive destruction (types III and IV) [6,7,8,9].…”

“…destruction of the acetabular ring, such as revision meshes and baskets, revision shells with or without a revision basket, structural bone grafts, highly porous titanium augment, and custom made implants [7,10]. The case is presented of a young woman with an extensive type IIIB defect of the acetabular ring, a type II defect of the proximal femur, and a fracture of the greater trochanter.…”

Survivorship and clinical outcomes of proximal femoral replacement in non-neoplastic primary and revision total hip arthroplasty: a systematic review

“…Reduced bone stock can be associated with septic and aseptic failure, periprosthetic fracture, osteoporotic fracture in the elderly with severe comminution or failed fracture fixation, and multiple revisions [ 2 – 7 ]. In case of severe proximal femoral bone loss multiple treatment options have been described in the literature, including structural allograft-prosthesis composite, impaction allografting, long revision stems, resection arthroplasty, and proximal femoral replacement (PFR) [ 3 , 4 , 8 ]. Proximal femoral replacement, also known as “megaprosthesis”, is a well-established limb salvage procedure for reconstruction of bone defects after the oncological resections of malignant bone neoplasms [ 9 ] and the encouraging outcomes have broadened the indications to the treatment of severe bone loss in non-oncologic conditions [ 10 , 11 ].…”

Excessive Blood Loss After Revision Hip Arthroplasty is Related to the use of Closed Suction Drainage: A Prospective Randomized Study

“…Different procedures such as mobile components exchange, partial reimplantation of a cup or stem, and the most di cult cases of total prosthesis reimplantation are performed during the RHA. An extended surgical approach, soft tissue damage and bone defects, longer time of surgery, and the need to use more complex implants for acetabulum or modular stems are the main features of RHA that in uence on higher complication rate including perioperative blood loss [3,4,5].…”