Abstract
In North America, and for the most part globally, a cementless acetabular component with adjuvant screw fixation is the preferred technique for revision total hip arthroplasty.
However, there are situations that involve massive pelvic bone loss that preclude the use of a cementless cup alone.
Options include:
- i)
Enhanced fixation components and augments
- ii)
Specialised constructs (cup/cage)
- iii)
Structural allografts
- iv)
Bone graft substitutes
Complex acetabular revisions present the arthroplasty surgeon with challenges that require an approach with more than one solution for all scenarios. While structural allografts have recently fallen out of favour with the increasing use of enhanced fixation components, there would still appear to be a role in the case in which bone stock restoration is a primary goal. The role of bone graft substitutes remains unclear, with supportive basic science data, but limited clinical experience to date. An algorithm will be discussed to assist in prioritising the multiple goals of acetabular reconstruction and one stock restoration.
