Uncemented Cups and Impaction Bone Grafting for Acetabular Bone Loss in Revision Hip Arthroplasty: A Review of Rationale, Indications, and Outcomes

Abstract

Total hip arthroplasty (THA) is increasingly performed in young patients and the number of revisions is estimated to rise over time. Acetabular osteolysis and bone loss are frequently encountered during revision and may be classified and treated in different ways. Impaction bone grafting (IBG) with morselized allograft offers a viable option. IBG was introduced over 40 years ago in combination with cemented cups, and is also used with uncemented cups. The impacted bone chips act as a void filler to restore bone stock; once incorporated they are substituted by host bone. Surgery entails assessment of the defect, acetabular preparation, preparation of the morselized graft, impaction of the graft, and cup implantation. Satisfactory medium- and long-term results have now been reported in most studies. With the advent of high-porosity cups, indications have been extended, enhancing the potential of IBG, in which primary stability of the cup to the host bone is essential for a successful procedure. Synthetic bone substitutes have also been used in combination with allogenic grafts and may extend the original technique for which long-term studies are warranted.

In Silico Contact Pressure of Metal-on-Metal Total Hip Implant with Different Materials Subjected to Gait Loading

“…Hard-on-hard bearings can be a choice for implants due to the disadvantages of hardon-soft, with the option of using metal or ceramic materials. To avoid revision surgery of hip joint implant recipients with high activity intensity and younger age, the use of metal-on-metal bearings may be considered [8]. This is because ceramic materials have brittle characteristics that endanger patients due to the high risk of failure from fracture caused by various high-intensity activities, generally carried out by younger patients [9].…”

Individualized megaimplants in acetabular revision arthroplasty: what have we learned in the last 15 years?

“…Opting for individualized megaimplants in acetabular revision arthroplasty is driven by the innate limitations associated with traditional implant solutions in adequately addressing extensive bone defects and achieving stable fixation (19,20). Many patients face the risk of severe bone loss or PD due to repeated acetabular revision surgeries (Fig.…”

Total Hip Arthroplasty in Protrusio Acetabuli: A Systematic Review

“…Various techniques for management of PA have been described in the literature. Commonly used techniques include the use of morselized impacted autografts or allografts with a cemented or uncemented cup for acetabular reconstruction, metal cages, reinforcement rings, and solid grafts for acetabular reconstruction 4 - 7 ) . The aim of this systematic review is to provide a comprehensive analysis of the current evidence, evaluate treatment efficacy, compare surgical techniques, and identify topics for future research.…”