Revision Total Hip Arthroplasty of an Acetabular Cup with Acetabular Bone Defects

Kyu Tae Hwang; Young Ho Kim

doi:10.5371/jkhs.2011.23.4.237

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Hwang and Kim: Revision Total Hip Arthroplasty of an Acetabular Cup with Acetabular Bone Defects

Review Article

The Journal of the Korean Hip Society

The Journal of the Korean Hip Society 2011; 23(4): 237-247.

Published online: 31 December 2011

DOI: https://doi.org/10.5371/jkhs.2011.23.4.237

Revision Total Hip Arthroplasty of an Acetabular Cup with Acetabular Bone Defects

Kyu Tae Hwang, MD, Young Ho Kim, MD

Department of Orthopedic Surgery, College of Medicine, Hanyang University, Seoul, Korea.

Address reprint request to Young Ho Kim, MD. Department of Orthopaedic Surgery, Hanyang University Guri Hospital, 249-1 Gyomun-dong, Guri 471-701, Korea. TEL: +82-31-560-2316, FAX: +82-31-557-8781, kimyh1@hanyang.ac.kr

Received 23 July 2011 Revised 23 October 2011 Accepted 27 October 2011

Abstract

Recently, the incidence of revision total hip arthroplasty (THA) has increased following primary THA. Bone stock deficiency presents the major challenge in acetabular reconstruction during revision hip arthroplasty. The reasons for such acetabular defects include osteolysis, bone resportion following cup loosening, iatrogenic damage resulting from cup or cement removal during revision THA, and cup migration. The pre-operative assessment of acetabular bone stock, including the amount and location of pelvic osteolysis before revision surgery, is a critical preoperative preparation for the treatment of bone deficiency. In cases with mild acetabular defects, a variety of surgical options are available for treating. However, in cases with severe segmental, cavitary, or combined acetabular defects, controversies have existed so far about the most optimal treatment.

Thereby, we tend to introduce the most commonly-adopted classification system of acetabular defects and management options using high hip center cups, oblong cups, structural allografts, morselized allografts with bipolar cups, morselized allografts with cementless cups, morselized allografts with acetabular reinforcement devices, and revisions with trabecular metal augmentations.

Keywords: Acetabular bone defect, Acetabular cup, Revision total hip arthroplasty

Figures and Tables

Fig. 1

(A) Preoperative radiograph showed severe acetabular osteolysis and cup loosening. (B) Postoperative radiograph showed allogenous structural bone graft with one screw. (C) Postoperative radiograph at 6 years showed incorporated graft bone and stable fixation of cup.

Fig. 2

(A) Preoperative radiograph showed severe acetabular osteolysis and cup loosening with polyethylene wear. (B) Revision surgery was performed using bipolar cup with allogenous morselized bone graft. (C) Postoperative radiograph at 5 years showed incorporation of grafted bone and stable fixation of femoral stem.

Fig. 3

(A) Preoperative radiograph showed severe acetabular osteolysis and cup loosening. (B) Postoperative radiograph showed fixation of cementless cup with allogenous morselized bone graft. (C) Postoperative radiograph at 7 years showed incorporated graft bone and stable fixation of cup.

Fig. 4

(A) Preoperative radiograph showed severe acetabular osteolysis and cup loosening. (B) Revision arthroplasty was performed using anti-protrusio cage with morselized bone graft. (C) Postoperative radiograph at 9 years showed incorporated graft bone and stable fixation of cup.

Fig. 5

Trabecular metal augmentation system.

Table 1

The AAOS Classification System for Acetabular Deficiencies

Table 2

The Paprosky's Classification System for Acetabular Deficiencies

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