Abstract
Acetabular revision surgery can be complex and challenging. The technique selected depends upon the amount of bone deficiency. One of the most useful ways to assess remaining bone stock has been described by Paprosky, based on the location and severity of bone loss, and the likelihood of obtaining a stable construct with a hemispherical cup.
In almost all cases of acetabular revision, the remaining bone is in fact capable of supporting a hemispherical socket, as long as details of technique are followed. The implant is larger than the native acetabulum and the removed socket by several sizes, and may approach quite large proportions, hence the term “Jumbo Cup”. The principle is to gradually enlarge the acetabulum with hemispherical reamers, taking care to protect the posterior and superior bone, at the expense of the less crucial anterior and inferior bone.
As reaming proceeds, there comes a point where the reamer is stable within the acetabulum. High areas have been reamed down, and remaining cavitary defects are then back-filled with autogenous reamings or allograft cancellous chips. This is then re-reamed in reverse to distribute the graft into the defects. A large or “Jumbo” cup, 2–3 mm larger than the last reamer, is then impacted into place, and supplemented with screws.
In many cases, the anterior lip, and to a lesser extent the medial wall, may be sacrificed to obtain stability, without compromising long-term results.
