Abstract
Introduction
Reconstructing acetabular defects in revision hip arthroplasty can be challenging. Small, contained defects can be successfully reconstructed with porous-coated cups without bone grafts. With larger uncontained defects, a cementless cup even with screws, will not engage with sufficient host bone to provide enough stability.
Porous titanium augments were originally designed to be used with cementless porous titanium cups, and there is a scarcity of literature on their usage in cemented cups with bone grafting.
Methods
We retrospectively reviewed five hips (four patients – 3 women, 1 man; mean age 65 years) in which we reconstructed the acetabulum with a titanium augment (Biomet, IN, USA) as a support for impaction bone grafting and cemented acetabular cups (Figure 1). All defects were classified according to Paprosky classification. Radiographic signs of osseointegration were graded according to Moore grading. Quality of life was measured with the Oxford Hip Score.
Results
At a minimum of one year follow-up, none of the patients required any further surgery for aseptic loosening or re-revision. The Oxford Hip Scores generally improved and two of the patients were very satisfied with the overall outcome of the surgery and would have undergone the surgery again for a similar problem. The patient that underwent bilateral acetabular reconstruction during a period one month, scored lowered than the other patients and was less satisfied with the outcome. Radiographs at the latest follow-up revealed incorporation of the augment with mean change in acetabular component inclination of less than 1° and cup migration of less than 5 mm in both horizontal and vertical axes.
Discussion
Acetabular reconstruction using porous titanium augments as a support for bone grafting and cemented acetabular cups can be an effective way of managing uncontained structural acetabular defect, with biocompatibility and osteoinducive characteristics. The early results are promising but longer follow-up is required.
