Revision Total Hip Arthroplasty: Acetabular Cup

Byung-Woo Min; Kyung-Jae Lee; Hyub Sagong

doi:10.5371/hp.2013.25.2.85

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Min, Lee, and Sagong: Revision Total Hip Arthroplasty: Acetabular Cup

Review Article

Hip & Pelvis 2013; 25(2): 85-94.

Published online: 30 June 2013

DOI: https://doi.org/10.5371/hp.2013.25.2.85

Revision Total Hip Arthroplasty: Acetabular Cup

Byung-Woo Min, MD, Kyung-Jae Lee, MD, Hyub Sagong, MD

Department of Orthopedic Surgery, School of Medicine, Keimyung University, Daegu, Korea.

Address reprint request to Byung-Woo Min, MD. Department of Orthopedic Surgery, School of Medicine, Keimyung University, 194 Dongsan-dong, Jung-gu, Daegu 700-712, Korea. TEL: +82-53-250-7729, FAX: +82-53-250-7205, min@dsmc.or.kr

Received 22 February 2013 Revised 14 May 2013 Accepted 14 May 2013

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Recently, the incidence of revision total hip arthroplasty following primary total hip arthroplasty has increased. However, revision after primary total hip arthroplasty is usually much more difficult than the first time, and the results are typically not as satisfactory as that after most primary total hip arthroplasty procedures. Therefore, thoughtful and thorough preoperative planning will certainly provides the patient with the best opportunity for long-term success.

In particular, location and size of acetabular bone defects dictate the type of acetabular component in revision in total hip arthroplasty. For most defects, a porous-coated hemispherical shell secured to host bone with multiple screws is the implant of choice. This reconstruction is feasible provided that at least 50% of the implant is in contact with host bone. When such contact is not possible, and there is adequate medial and peripheral bone, techniques using alternative uncemented implants can be used for acetabular reconstruction. Defects with greater bone loss or compromised columns require the use of either modular augments combined with a hemispherical shell, reconstruction cages, structural allografts, or impaction allograft.

Therefore, we attempt to introduce the most commonly-adopted system for classification of acetabular defects and the necessary preoperative evaluation, intraoperative detail, and reported results of these acetabular revisions.

Keywords: Revision total hip arthroplasty, Acetabular component revision

Figures and Tables

Fig. 1

Axial CT image shows the artifact suppressed CT image.

Fig. 2

The illustration of Paprosky's Classification of Acetabular Deficiences.

Fig. 3

(A) Trabecular metal modular augments and (B) uncemented acetabular cup. These cups and augments are manufactured in multiple sizes and shapes to accommodate various bony defects.

Fig. 4

Intraoperative photograph showing a well-fixed cup. The lesion was debrided through the screw hole in the cup with curettes.

Fig. 5

Intraoperative photograph shows cementation of a polyethylene liner into a metal shell.

Fig. 6

A postoperative radiograph shows acetabular reconstruction using the high hip center technique.

Fig. 7

A radiograph shows acetabular reconstruction using 67 mm jumbo porous-coated components.

Fig. 8

Radiograph obtained 7 years after surgery shows a well fixed Ganz reinforcement ring.

Fig. 9

A radiograph shows acetabular reconstruction with a structural allograft.

Table 1

The AAOS Classification of Acetabular Deficiences

Table 2

The Paprosky's Classification of Acetabular Deficiences

Table 3

Results of Jumbo Cup in Acetabular Revision

Table 4

Results of Morselized Bone Chips Allograft with Cementless Cup Revision

Table 5

Results of Structural Allograft

Table 6

Results of Impaction Allograft in Acetabular Revision

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