Hip Pelvis.  2013 Jun;25(2):85-94. 10.5371/hp.2013.25.2.85.

Revision Total Hip Arthroplasty: Acetabular Cup

• Min BW
• Lee KJ
• Sagong H

• KMID: 2054144
• DOI: http://doi.org/10.5371/hp.2013.25.2.85

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.

Keyword

Revision total hip arthroplasty; Acetabular component revision

MeSH Terms

Arthroplasty
Hip
Humans
Incidence
Transplantation, Homologous

Figure

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  Fig. 1 Axial CT image shows the artifact suppressed CT image.

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  Fig. 2 The illustration of Paprosky's Classification of Acetabular Deficiences.

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  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.

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  Fig. 4 Intraoperative photograph showing a well-fixed cup. The lesion was debrided through the screw hole in the cup with curettes.

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  Fig. 5 Intraoperative photograph shows cementation of a polyethylene liner into a metal shell.

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  Fig. 6 A postoperative radiograph shows acetabular reconstruction using the high hip center technique.

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  Fig. 7 A radiograph shows acetabular reconstruction using 67 mm jumbo porous-coated components.

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  Fig. 8 Radiograph obtained 7 years after surgery shows a well fixed Ganz reinforcement ring.

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  Fig. 9 A radiograph shows acetabular reconstruction with a structural allograft.

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