The Paprosky acetabular bone defect classification system and related algorithms for acetabular reconstruction cannot properly guide cementless acetabular reconstruction in the presence of porous metal augments. We aimed to introduce a rim, points, and column (RPC)-oriented cementless acetabular reconstruction algorithm and its clinical and radiographic outcomes. A total of 123 patients (128 hips) were enrolled. A minimum 5-year radiographic follow-up was available for 96 (75.8%) hips. The mean clinical and radiographic follow-up durations were 6.8±0.9 (range: 5.2–9.2) and 6.3±1.9 (range: 5.0–9.2) years, respectively. Harris hip score (HHS) improved significantly from 35.39±9.91 preoperatively to 85.98±12.81 postoperatively (P<0.001). Among the fixation modes, 42 (32.8%) hips were reconstructed with rim fixation, 42 (32.8%) with three-point fixation without point reconstruction, 40 (31.3%) with three-point fixation combined with point reconstruction, and 4 (3.1%) with three-point fixation combined with pelvic distraction. Complementary medial wall reconstruction was performed in 20 (15.6%) patients. All acetabular components were radiographically stable. Nine-year cumulative Kaplan–Meier survival rates for 123 patients with the endpoint defined as periprosthetic joint infection, any reoperation, and dissatisfaction were 96.91% (confidence interval [CI]: 86.26%, 99.34%), 97.66% (CI: 92.91%, 99.24%), and 96.06% (CI: 86.4%, 98.89%), respectively. Cup stability in cementless acetabular reconstruction depends on rim or three-point fixation. The continuity of the anterior and posterior columns determines whether the points provide adequate stability to the cup. Medial wall reconstruction is an important complementary fixation method for rim or three-point fixation. The patients who underwent cementless acetabular reconstruction guided by the RPC decision-making algorithm demonstrated satisfactory mid-term clinical function, satisfaction levels, radiographic results, and complication rates

Aims. Post-traumatic periprosthetic acetabular fractures are rare but serious. Few studies carried out on small cohorts have reported them in the literature. The aim of this work is to describe the specific characteristics of post-traumatic periprosthetic acetabular fractures, and the outcome of their surgical treatment in terms of function and complications. Methods. Patients with this type of fracture were identified retrospectively over a period of six years (January 2016 to December 2021). The following data were collected: demographic characteristics, date of insertion of the prosthesis, details of the intervention, date of the trauma, characteristics of the fracture, and type of treatment. Functional results were assessed with the Harris Hip Score (HHS). Data concerning complications of treatment were collected. Results. Our series included 20 patients, with a mean age of 77 years (46 to 90). All the patients had at least one comorbid condition. Radiographs showed that 75% of the fractures were pure transverse fractures, and a transverse component was present in 90% of patients. All our patients underwent surgical treatment: open reduction and internal fixation, revision of the acetabular component, or both. Mean follow-up was 24 months, and HHS at last follow-up was 75.5 (42 to 95). The principal complications observed were dislocations of the prosthesis (30%) and infections (20%). A need for revision surgery was noted in 30% of patients. No dislocation occurred in patients undergoing osteosynthesis with acetabular reconstruction. We did not note either mechanical loosening of the acetabular component nor thromboembolic complications. In all, 30% of patients presented acute anemia requiring transfusion, and one death was reported. Conclusion. Post-traumatic periprosthetic acetabular fractures frequently have a transverse component that can destabilize the acetabular implant. The frequency of complications, principally dislocations, led to a high rate of revision surgery. Improvements in preoperative planning should make it possible to codify management to reduce this high rate of complications. The best results were obtained when the surgical strategy combined osteosynthesis with acetabular reconstruction. Cite this article: Bone Jt Open 2024;5(1):28–36

Fifty-one prospectively followed Contour_ acetabular reconstruction cages, inserted through the direct lateral approach, were reviewed at three years minimum follow-up (range 3 to 6.4 yrs.). To date, four reoperations were required (two each for sepsis and instability) with no failures due to aseptic loosening. The Kaplan-Meier Survival Rate for any reoperation was 87% at 6.4 years. Short to mid-term follow-up of a single type of acetabular reconstruction cage, inserted through the lateral approach, demonstrated this to be a successful reconstruction option in the management of large acetabular bone defects. This study reports the mid-term results of a single design of acetabular reconstruction cage inserted through the direct lateral approach. At minimum three years follow-up (range 3 to 6.4 yrs.), there were no failures due to aseptic loosening with only four of fifty-one cases requiring reoperation (two sepsis, two instability). This review supports the use of the reconstruction cage, inserted through the lateral approach, for large defects that cannot be managed with a hemispherical porous implant. The use of the reconstruction cage in our center is reserved for large defects that cannot be managed with a hemispherical porous implant because of insufficient bone stock for initial implant stability and/or host bone contact for in-growth. Fifty-one consecutive prospectively followed Contour_ (Smith and Nephew) acetabular reconstruction cages, inserted through the direct lateral approach, were reviewed at three years minimum follow-up (range 3 to 6.4 yrs.). The majority of cases were AAOS Type Three and Four defects in which morsellized allograft was used in forty-nine cases and structural graft in three cases. Harris hip scores improved from 32.1±17.8 pre-op to 65.3±24.1 at most recent follow-up. Defining any acetabular reoperation as a failure, four of the fifty-one cages were considered to have failed giving a Kaplan-Meier Cumulative Survival Rate of 87% at 6.41 years. Two reoperations were for recurrent dislocation and the other two for sepsis. None of the fifty-one cages have been revised for aseptic loosening to date

Aims. Custom-made partial pelvis replacements (PPRs) are increasingly used in the reconstruction of large acetabular defects and have mainly been designed using a triflange approach, requiring extensive soft-tissue dissection. The monoflange design, where primary intramedullary fixation within the ilium combined with a monoflange for rotational stability, was anticipated to overcome this obstacle. The aim of this study was to evaluate the design with regard to functional outcome, complications, and acetabular reconstruction. Methods. Between 2014 and 2023, 79 patients with a mean follow-up of 33 months (SD 22; 9 to 103) were included. Functional outcome was measured using the Harris Hip Score and EuroQol five-dimension questionnaire (EQ-5D). PPR revisions were defined as an endpoint, and subgroups were analyzed to determine risk factors. Results. Implantation was possible in all cases with a 2D centre of rotation deviation of 10 mm (SD 5.8; 1 to 29). PPR revision was necessary in eight (10%) patients. HHS increased significantly from 33 to 72 postoperatively, with a mean increase of 39 points (p < 0.001). Postoperative EQ-5D score was 0.7 (SD 0.3; -0.3 to 1). Risk factor analysis showed significant revision rates for septic indications (p ≤ 0.001) as well as femoral defect size (p = 0.001). Conclusion. Since large acetabular defects are being treated surgically more often, custom-made PPR should be integrated as an option in treatment algorithms. Monoflange PPR, with primary iliac fixation, offers a viable treatment option for Paprosky III defects with promising functional results, while requiring less soft-tissue exposure and allowing immediate full weightbearing. Cite this article: Bone Jt Open 2024;5(8):688–696

Managing severe acetabular bone defects during primary and revision total hip arthroplasty is a challenging problem. Standard treatment options for this cases is using of acetabular reconstruction type-Burch-Schneider rings. Unfortunately, the possibility of osseointegration of these implants with surrounding bone has always remained a contentious issue. The emergence in recent years of new designs of trabecular titanium, representing a symbiosis of acetabular reconstructive plates and modular cup helped to solve this problem on a completely new level. The aim of this prospective study is to evaluate the short and mid-term clinical and radiographic outcomes of different types of acetabular revision cups - old and new design. From 2006 to 2015, we performed 48 acetabular reconstruction with reconstruction rings CONTUR Smith and Nephew(group 1) and 34 operations with Delta TT Lima Revision system (group 2). The mean age of patients was 59.2 years (range 30–79). Indications for operations included fractures in acetabular region (10 pat – 12,2 %), acetabular nonunions with bone defects (14 pat – 17,1%), aseptic loosening with multiple dislocation of the primary implants in 38 cases (46,3%) and second stage of infection treatment in 20 cases (24.4%). Clinical and functional outcomes were evaluated by Harris Hip Score (HHS). Bone density in Charnley's zones was measured by dual-energy x-ray absorptiometry. With CONTUR reconstruction rings were used 3 different types of bearing surface articulation (22 metal/polyethylene, 10 ceramic/polyethylene, and 16 oxinium/polyethylenel). With Delta TT Revision system were used metal/poly couples in 22 cases, ceramic/poly in 6 cases, and ceramic/ceramic couple in 4 cases. In two patients with high risk of dislocations were used double mobility system. In all operations with CONTUR rings was used bone impaction grafting to fill cavitary defects (Paprosky 2B-3A), with Delta TT Revision system in 14 cases (41,2%) additionally TT augments were used. In group 1 were 3 dislocations (6,3 %), 2 deep infections (4,2 %) and 4 aceptic loosenings with secondary instability of implants (8,3 %). In group 2 Trabecular Titanium showed a high capacity of osseointegration, providing good results in short-term follow-up. We registered only 2 dislocations (5,8 %) and 1 aceptic loosening (2,9 %). The mean HHS increased from 39.7 (range 23–62) preoperatively to 86.5 (range 68–98) at the last follow-up examination. The implanted cups were radiographically stable at the last follow-up visit (1 and 2 years) without radiolucent lines or periprosthetic osteolysis. Conclusions. Delta Revision TT is a good solution for acetabular reconstruction even when there are cavitary and segmental bone defects. Modularity of this system make it possible to correct inlay position, center of hip rotation and minimising the risk of dislocation

Introduction. Acetabular reconstruction of a total hip arthroplasty (THA) for a case with severe bone loss is most challenging for surgeon. Relatively high rate of failure after the reconstruction surgery have been reported. We have used Kerboull-type acetabular reinforcement devices with morsellised or bulk bone allografts for these cases. The purpose of this study was to examine the midterm results of revision THA using Kerboull-type acetabular reinforcement devices. Patients and methods. We retrospectively reviewed 20 hips of revision THA (20 patients) between February 2002 and August 2010. The mean age of the patients at the time of surgery was 67.4 years (range 45–78). All of the cases were female. The mean duration of follow-up was 6.5 years (range 2.1–10.4). The reasons of revision surgeries were aseptic loosening in 10 hips, migration of bipolar hemiarthroplasty in 8 hips, and rheumatoid arthritis in 2 hips. We classified acetabular bone defects according to the American Academy of Orthopaedic Surgeons (AAOS) classification; we found two cases of Type II and eighteen cases of Type III. In terms of bone graft, we performed both bulk and morsellised bone grafts in 6 hips and morsellised bone grafts only in 14 hips. We assessed cup alignment using postoperative computed tomography (CT) and The post-operative and final follow-up radiographs were compared to assess migration of the implant. We measured the following three parameters: the angle of inclination of the acetabular device (Fig. 1); the horizontal migration (Fig. 2a); and vertical migration (Fig. 2b). Substantial migration was defined as a change in the angle of inclination of more than 3 degrees or migration of more than 3 mm. The pre- and postoperative hip functions were evaluated using the Japanese Orthopaedic Association (JOA) hip score. Results. The mean cup inclination and anteversion were 38.4 degrees and 10.6 degrees, respectively. The mean change in the angle was 1.9 degrees in inclination of the device. The average horizontal migration was 1.0 mm, and the vertical migration was 2.0 mm. Only one hip showed substantial migration with breakage of the device. This failure case represented a large amount of posterior pelvic tilt in standing position postoperatively. The mean JOA hip score was increased from 46.7 to 74.8. Discussion. Poor outcome using Kerboull-type reinforcement plate with morsellised bone graft only has been demonstrated by many reports. In these literatures, bulk bone graft was recommended particularly in the case of large bone defect such as larger than half of the rounded plate of the device or more than 2 cm of thickness. In our case series, acetabular reconstruction using a Kerboull- type acetabular reinforcement device and bone graft gives satisfactory mid-term results even with morsellized bone graft only. One possible interpretation is that most of our cases had relatively small bone defect according to the staging of severity of the superior segmental bone loss made by Kawanabe et al. We suggest that the progressive posterior pelvic tilt should be considered to be a risk of poor outcome of the acetabular reconstruction using this device. To view tables/figures, please contact authors directly

Aims. Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. Methods. A multicentre observational cohort study in Australia between February 2017 and March 2021 included consecutive patients undergoing acetabular reconstruction with CTACs in rTHA (Paprosky 3A/3B defects) or tumour resection (including Enneking P2 peri-acetabular area). Of 103 eligible patients (104 hips), 34 patients (35 hips) were analyzed. Results. CTAC positioning was generally accurate, with minor deviations in cup inclination (mean 2.7°; SD 2.84°), anteversion (mean 3.6°; SD 5.04°), and rotation (mean 2.1°; SD 2.47°). Deviation of the hip centre of rotation (COR) showed a mean vector length of 5.9 mm (SD 7.24). Flange positions showed small deviations, with the ischial flange exhibiting the largest deviation (mean vector length of 7.0 mm; SD 8.65). Overall, 83% of the implants were accurately positioned, with 17% exceeding malpositioning thresholds. CTACs used in tumour resections exhibited higher positioning accuracy than rTHA cases, with significant differences in inclination (1.5° for tumour vs 3.4° for rTHA) and rotation (1.3° for tumour vs 2.4° for rTHA). The use of intraoperative navigation appeared to enhance positioning accuracy, but this did not reach statistical significance. Conclusion. This study demonstrates favourable CTAC positioning accuracy, with potential for improved accuracy through intraoperative navigation. Further research is needed to understand the implications of positioning accuracy on implant performance and long-term survival. Cite this article: Bone Jt Open 2024;5(4):260–268

Introduction. Acetabular revision surgery is becoming more prevalent with an estimated increase of 137% by 2030. It is challenging surgery especially in the presence of deficient bone loss. Several techniques of acetabular reconstruction are used world-wide. The greater the bone loss (Paprosky Type IIIA and IIIB, and AAOS Classification of Acetabular Bone Loss Type 3 and 4) the more complex are the reconstruction methods. There is however, insufficient literature comparing the contemporary techniques of revision acetabular reconstruction and their outcomes. Objectives. The purpose of this study was to systematically review the literature and to report clinical outcomes and survival of contemporary acetabular revision arthroplasty techniques (tantalum metal (TM) systems, uncemented revision jumbo cups, reinforced devices such as cages and rings, oblong cups and custom-made triflange cups). We specifically looked at outcomes when reconstruction was undertaken in the presence of bone loss. Methods. Full-text papers and those with an abstract in English published from January 2001 to October 2015, identified through international databases, Medline (PubMED), EMBASE, CINHAL, Web of Science, Cochrane and Google scholar databases, were reviewed. Studies reporting failure and complications following the use of tantalum metal systems, uncemented revision jumbo cups, reinforced devices as cages and rings, oblong cups and custom-made triflange cups, were included. Functional and radiological outcomes were also evaluated. Results. A total of 50 papers of level IV scientific evidence, comprising 2811 hips in total, fulfilled the inclusion criteria and were included. 1021 hips (291 of them classified Paprosky Type 3A, 98 3B and 14 AAOS type 3 and 2 type 4) with a mean follow-up 48.9 months, used TM cups with a mean overall re-revisions rate of 7.3%. 831 hips (156 of them classified Paprosky Type 3A, 178 3B and 228 AAOS type 3 and 43 type 4) with a mean follow-up 87.5 months, were reconstructed using cages and rings devices; these had a mean re-operation rate of 11.0%. 203 hips (44 of them classified Paprosky Type 3A and 8 3B) with a mean follow-up 90.9 months, were reconstructed using oblong cups and were associated with a mean of re-operate rate of 5.9%. In 518 hips (86 of them classified Paprosky Type 3A, 29 3B and 114 AAOS type 3 and 2 type 4) with a mean follow-up 117.4 months, jumbo cups were implanted and revision rate was 12.1%. Custom-made triflange cups were used in 238 hips (3 of them classified Paprosky Type 3A, 64 3B and 42 AAOS type 3 and 139 type 4) with a mean follow-up 57.9 months, and they were re-roperated in 16.8% of cases. Overall patients had improved post-operative hip scores for each different procedure. We have observed that oblong cups components had a lower failure rate compared with other different materials considered in this review. Custom-made triflange cups had one of higher failure rate, however they had been used in the most complex cases. It is possible that other designs had more favourable outcomes having been used in less demanding patients. Conclusions. This review confirms successful acetabular reconstructions using several techniques and highlights key features and outcomes of different techniques. In particular oblong and TM cups have proven long-term survivorship and our results strongly suggest these devices as preferable choice especially in moderate to high-grade acetabular defects. For hip revisions following the development of pelvic discontinuity custom-made triflange cups have a main role, however the results are not always favourable

Introduction: Between 1990 and 2000 we reconstructed 123 hips in 110 patients using impaction bone grafting with frozen, morsellised irradiated femoral heads and cemented sockets. This review presents the medium to long term survivorship of irradiated allograft in acetabular reconstruction in our cohort of patients. Patients and Methods: Patients were reviewed in out-patients. Radiographs were examined for union, lucency and component migration. The mean age at revision with allograft was 64.3 years (26 to 97). 86 hips (70%) in 74 patients were reviewed both clinically and radiologically. At the time of review 28 patients (29 hips) had died and 5 patients (5 hips) were lost to follow up. Of those patients who had died 18 hips had been followed up to a mean of 66 months (12–145). A further 3 hips were unable to attend for clinical review but had accurate implant-allograft survivorship data. Their data were included in survivorship analysis to the time of last clinical review. Results: There have been 19 revisions; 9 for infection, 7 for aseptic loosening and 3 for dislocation. In surviving acetabular reconstructions, union of the graft had occurred in 64 out of 67 hips (95.5%). Radiolucent lines at the bone cement interface were seen in 12 hips (17.9%; 9 in a single DeLee zone and 3 in multiple zones) but none were considered loose. Migration of the acetabular component greater than 5mm was seen in 3 hips (4.5%). Survivorship analysis using revision as an end point for all indications at 10 years was 83.3% (95% C.I. 68 to 89%) and 71.3% (95% C.I. 58 to 84%) at 15 years. Conclusion: Acetabular reconstruction using irradiated allograft and a cemented cup is an effective reliable technique with good results in the medium to long term comparable to series using non irradiated freshly frozen bone

Aims. After failed acetabular fractures, total hip arthroplasty (THA) is a challenging procedure and considered the gold standard treatment. The complexity of the procedure depends on the fracture pattern and the initial fracture management. This study’s primary aim was to evaluate patient-reported outcome measures (PROMs) for patients who underwent delayed uncemented acetabular THA after acetabular fractures. The secondary aims were to assess the radiological outcome and the incidence of the associated complications in those patients. Methods. A total of 40 patients underwent cementless acetabular THA following failed treatment of acetabular fractures. The postoperative clinical and radiological outcomes were evaluated for all the cohort. Results. The median (interquartile range (IQR)) Oxford Hip Score (OHS) improved significantly from 9.5 (7 to 11.5), (95% confidence interval (CI) (8 to 10.6)) to 40 (39 to 44), (95% CI (40 to 43)) postoperatively at the latest follow-up (p < 0.001). It was worth noting that the initial acetabular fracture type (simple vs complex), previous acetabular treatment (ORIF vs conservative), fracture union, and restoration of anatomical centre of rotation (COR) did not affect the final OHS. The reconstructed centre of rotation (COR) was restored in 29 (72.5%) patients. The mean abduction angle in whom acetabular fractures were managed conservatively was statistically significantly higher than the surgically treated patients 42.6° (SD 7.4) vs 38° (SD 5.6)) (p = 0.032). We did not have any case of acetabular or femoral loosening at the time of the last follow-up. We had two patients with successful two-stage revision for infection with overall eight-year survival rate was 95.2% (95% CI 86.6% to 100%) with revision for any reason at a median (IQR) duration of follow-up 50 months (16 to 87) months following THA. Conclusion. Delayed cementless acetabular THA in patients with previous failed acetabular fracture treatments produces good clinical outcomes (PROMS) with excellent survivorship, despite the technically demanding nature of the procedure. The initial fracture treatment does not influence the outcome of delayed THA. In selected cases of acetabular fractures (either nondisplaced or with secondary congruency), the initial nonoperative treatment neither resulted in large acetabular defects nor required additional acetabular reconstruction at the time of THA. Cite this article: Bone Jt Open 2021;2(12):1067–1074

Acetabular component loosening and pelvic osteolysis continue to be a significant clinical challenge in revision hip arthroplasty. We present results of 339 cases of acetabular reconstruction with impacted allograft. All patients who under went acetabular reconstruction with impaction allograft between July 1995 and July 1999 were included. Clinical and radiographic data was collected prospectively. There were 339 patients identified. Average age was 71 years. The majority were first time revisions (201) but the group includes 2nd, 3rd and 4th revisions with 34 two-stage revisions and 44 primary arthroplasties. There were multiple surgeons with 2/3 being consultants and 1/3 fellows. Pre and post-operative clinical assessment included Oxford and Harris hip scores, and a modified Charnley score for pain, function and range of movement. Pre-operative radiographs were classified with the Paprosky classification. Follow up radiographs were assessed for graft thickness, component migration, graft reabsorption and lucent lines. There were 10 grade I, 205 grade II, and 103 grade III defects with 3 pelvic discontinuities. Reconstruction methods included impaction only, rim and/or medial mesh, KP plate fixation and reinforcement cages. Follow up average was 6.1 years (4.3 – 8.4) and no patient was lost. Infection was identified in 13 patients (5 recurrent 89% eradication and 8 new 2.6%). There were 6 nerve injuries, 2 remain unresolved and 13 patients dislocated (3.8%). There have been 46 deaths in the group with 3 being peri-operative. There have been 18 re-operations for aseptic loosening. 7 KP plates fractured, 1 cage migrated and 10 rim meshes failed. Factors associated with aseptic loosening include use of a large rim mesh particularly with an allograft thickness of > 2cm. We conclude that impaction allografting is a reliable method for acetabular reconstruction. Careful consideration should be given when allograft thickness will be > 2cm and a large rim mesh is required

Introduction. Severe acetabular bone stock loss compromises the outcome in primary and revision total hip arthroplasty. This acetabular deficienca occurs very often in Rheumatoid Arthritis. In 1979 a biologic method was introduced with tightly impacted cancellous allograft in combination with a cemented polyethylene cup for acetabular reconstruction. With this technique it is possible to replace the loss of bone and restore hip function with a standard implant. Because of the poor long term results and our own experience with large solid grafts we started in 1998 to use the impaction grafting in primary and revision hip replacements in Osteoarthritis and Rheumatoid Arthritis. Materials and Methods. Between 1998 and 2001 35 acetabular reconstructions were performed in 29 patients with rheumatoid arthritis. 3 Patients were lost to follow up. 24 primary and 11 Revision Arthroplasties were performed. The average age was 55( 22-73. 29 female, 6 male. 58 Patients had additional dysplasia. We had cavitary, segmental and also combined defects. Femoral head autografts were used in all primaries, allografts were used in revision surgery. Firstly the peripheral and central segmental defects were close with a metal mesh, so that only a cavitary defect remained. The cavity was filled with bone chips which were impacred layer by layer. To strabilize these reconstruction cement was used in direct contact with the graft. In the Merle d’ Aubigne Score an improvement in pain, walking ability and function were observed. We had 1case of aseptic loosening, in a 73 year old female. After 10 month the grafts were incorporated. Our results are short term results- compared to the international literature ( Rosenberg et al. ) Nevertheless we can confirm the technique can be used with good results in cases with severe acetabular defects due to rheumatoid arthritis

Though over ten-year follow-up results of impaction bone grafting for acetabular reconstruction from European countries are available in literatures, clinical reports from Asian countries are rare. The purpose of the present study is to assess mid-term clinical and radiographic follow-up results at least three years after acetabular reconstruction with impaction bone grafting technique by single surgeon in Japanese cohort. The senior author performed 24 acetabular revisions with impaction bone grafting technique in 24 patients from February 2001 to June 2005. The average age of the patients at the revision was 67.5 years (36–82 years). The average follow-up period was 5 years and 5 months (3–7.3 years). The reasons for the operation were aseptic loosening of sockets in 17 hips and migration of bipolar heads in seven. The acetabular bone defects were classified as cavitary in 3 hips and as combined segmental-cavitary in 21 hips according to AAOS classification. For clinical assessment, Merle d’Aubigné and Postel hip score was assessed. Peri-operative complications were recorded. For radiological assessment, antero-posterior hip radiograph was analyzed pre-operatively, and post-operatively at one month, 6 months and every 6 months thereafter. Clear lines more than 2 mm around the sockets using DeLee and Charnley zone classification, and migration of the sockets were assessed. Hodgikinson’s type 3 (complete demarcation line) and type 4 (migration more than 5 mm or change of the angle more than 5 degrees) were classified as “loosening”. Kaplan-Meier survival analysis was performed with radiographic loosening and any re-operation (including recommendation for the re-operation) for the sockets as the end point, respectively. The mean Merle d’Aubigné and Postel hip score improved from 11.5 points before operation to 15.7 points at the final follow-up. Though, intra-operative blow-out fracture of the acetabular floor was detected in 3 hips, re-containment had been achieved by adding metal mesh or bone graft. Clear lines at cement-bone interface were detected at zone 3 in 2 hips. Migration more than 5 mm was detected in 2 hips of type III defect at 2 years and 6 months. Re-revision was recommended for one migrated hip at 3 years and 6 months after the operation, and the other hip was stable with no clinical symptom without progressive migration at the final follow-up of 5 years. The Kaplan-Meier survival analysis, with loosening and re-operation as the end point, predicted a rate of survival of the socket of 91.7% and 95.2% at 5 years, respectively. In conclusion, acetabular reconstruction with impaction bone grafting is attractive, but technical demanding procedure. The survival rate of the present series was compatible with the results of previous literatures. However, careful follow-up is essential, especially for the cases with massive bone defect

In revision THA, the solid acetabular reconstruction in the true acetabulum is often challenging. We are using the Kerboull acetabular reinforcement devices after packing hydroxyapatite granules for acetabular bone defects. We report our 3–7 year clinical and roentgenographical results. Twenty-one acetabuli in 20 patients were reconstructed in the true acetabuli with Kerboull-type acetabular reinforcement devices and porous hydroxyapatite granules (Sumitomo Pharmaceutical Co. Ltd.). The mean age of the patients at operation was 68 years. The mean follow-up period was 5 years and 3 months (38–88 months). Acetabular bone deficiencies were evaluated according to AAOS classification (type II: 5 hips, type III: 16 hips). Porous hydroxyapatite granules (20–60 grams) were grafted to all the acetabuli. Autologous cortico-cancellous bone grafts or hydroxyapatite blocks were used to reconstruct the segmental defects in 6 hips. All the acetabuli were reinforced with Ker-boull-type reinforcement devices and Charnley-type cemented prostheses were implanted. Clinical and roent-genographical results were evaluated using Japanese Orthopaedic Association hip score and Hodgkinson classification. Average hip score was improved from 42 points to 75 points. No re-revision was done. No infection was noted. The roentgenograms showed neither migration nor loosening of the acetabular components. Porous hydroxyapatite granules are one of the best bone substitutes because of their mechanical and biochemical properties. Oonishi reported very good results of his acetabular reconstruction using this material. The Kerboull-type acetabular devices are very effective to the reconstruction in the true acetabulum. Excellent results of these devices were reported by Kerboull. Ace-tabular reconstrution using both of them showed very good clinical and roentgenographical results during 3 to 7 post-operative years in our series

The treatment of acetabular metastases with total hip arthroplasty is technically challenging often with significant loss of structural continuity in the medial wall and roof of the acetabulum, as described by Harrington in 1981 as class III defects. Traditionally the acetabular component is stabilised with Harrington rods but the risk of post-operative complications, especially bleeding is significant. We performed 10 consecutive total hip arthroplasties in patients with metastases involving the acetabulum with Harrington class III defects. The first three patients had acetabular reconstruction with a Kerboull cage, (Stryker Howmedica.) The cage was secured using a combination of screw fixation to the ileum and PMMA cement filling voids behind the cage. A polyethylene acetabular cup is then cemented into the cage. There was concern about the superior fixation using this implant and so the remaining 7 patients were treated using the Graft Augmentation Prosthesis (GAP II), (Stryker How-medica.) This is a titanium reconstruction cage with two superior flanges allowing extensive screw fixation onto the ileum. Two patients had very large defects where there was not sufficient support to use this cage alone, so the technique was augmented with Harrington rods. No implants have failed to date. One patient, an 83 year old female, died 23 days post-operatively after suffering a stroke. Two patients died of their disease 95 and 115 days after surgery. The remaining patients continue to have good pain and mobility following surgery as demonstrated by the Oxford hip score. We conclude that in suitable patients with extensive metastatic involvement of the acetabulum, a flanged acetabular reconstruction cage prosthesis is much improved way of providing support for a total hip replacement. This procedure can greatly improve quality of life, and to date we have had no mechanical failures of fixation using this technique

Background and Objective. Total hip arthroplasty (THA) has been applied to treat pain and disability in patients with post-traumatic arthritis after acetabular fracture for many years. However, the midterm and long-term results of THA for this unique population are still controversial. According to previous studies, we found that uncemented acetabular reconstructions were usually performed in patients who were most likely to have the best results and an abnormal acetabular structure was usually the reason for THA failure. In this study, we evaluated the midterm results of using uncement acetabular components to treat posttraumatic arthritis after acetabular fracture. In addition, we investigated the effects of different acetabular fracture treatments and fracture patterns on THA. Materials and Methods. Between January 2000 to December 2003, 34 uncemented acetabular reconstructions were performed in 34 patients for posttraumatic arthritis after acetabular fractures. Among them, 31 patients underwent complete clinical and radiographic follow-up for an average of 6.3 years (range, 3.1–8.4 years). There were 22 men and 9 women. The patients' average age was 51 ± 12 years (range, 27–74 years) at the time of arthroplasty. The average interval from fracture to THA was 5.58 ± 4.42 years (range, 0.75–17.5 years). Of the 31 patients, 19 had undergone ORIF (open-reduction group) and 12 had received conservative treatment for the acetabular fractures (conservative-treatment group). Then, 14 had simple pattern fractures (simple group) and 17 had complex pattern fractures (complex group). After midterm follow-up, the radiographic and clinic results of the different groups were compared. Results. During 6.3 years' follow up, no infection occurred and no revision was needed in the 31 patients. In the open-reduction and conservative-treatment groups, the respective averages for duration of surgery, intraoperative blood loss, and amount of blood transfused were 138 ± 29 minutes and 98 ± 16 minutes (P < .001), 726 ± 288 mL and 525 ± 101 mL (P = .01), and 1,130 ± 437 mL and 1,016 ± 422 mL (P = .62). In the complex group and the simple group, the respective averages for duration of surgery, intraoperative blood loss, and amount of blood transfused were 132 ± 28 minutes and 109 ± 31 minutes (P = .042), 741 ± 221 mL and 536 ± 248 mL (P = .02), and 1,100 ± 414 mL and 1,075 ± 456 mL (P = .91). The average Harris Hip Score increased from 49 ± 15 before surgery to 89 ± 5 in the latest follow up, and 29 patients (94%) had either excellent or good results. The average Harris Hip Score for the open-reduction group and the conservative-treatment group increased to 87 ± 6 and 91 ± 3 (P = .07), respectively, after surgery; for the complex group and the simple group, it increased to 88 ± 6 and 90 ± 4 (P = .25), respectively. There was no significant difference between the open-reduction group and the conservative-treatment group or between the complex group and the simple group regarding the number of hips with excellent and good results. Of our 31 patients, none had a change in acetabular component abduction of >4°. The average horizontal migration of cup was 1.48 ± 0.46 mm (range, 0.7–2.33 mm), and the average vertical migration was 1.41 ± 0.54 mm (range, 0.5–2.51 mm). The average rate of polyethylene liner wear was 0.25 ± 0.11 mm/y (range, 0.03–0.41 mm/y). Average wear rates were 0.25 ± 0.12 mm/y and 0.24 ± 0.11 mm/y for the open-reduction group and the conservative-treatment group (P = .72), respectively, and 0.24 ± 0.13 mm/y and 0.26 ± 0.10 mm/y in the complex group and the simple group (P = .67), respectively. The average rate of polyethylene wear for all patients was positively related to BMI (r = .36; P = .047). After THA, all 31 patients had a reconstructed hip center within 20 mm of vertical and horizontal symmetry compared with the contralateral hip, including 27 patients (87%) with anatomic restoration and 4 patients with reconstructed hip center between 10–20 mm of vertical and horizontal symmetry. Anatomic restoration was positively related to fracture treatment (r = .48; P = .006), but it had no relation to fracture pattern (r = .16; P = .40). Conclusion. Uncement acetabular reconstruction following acetabular fracture had favorable midterm results. Fracture treatments and patterns are associated with increased operative time and hemorrhage amount. Open reduction and internal fixation of fracture favours anatomic restoration of hip rotational center

Metastatic bone disease resulting in acetabular destruction can provide the orthopaedic surgeon with the difficult challenge of achieving a stable reconstruction of the hip to provide pain relief and restoration of mobility. We review of twenty patients with metastatic disease requiring major acetabular reconstruction presenting to our orthopaedic oncology unit over a five year period was undertaken. This yielded 15 female and 5 male patients with mean age 59 years. The primary lesion was breast (8 cases), renal (3) prostate (2), myeloma (2) and others (5) with a solitary acetabular metastasis in 75% of cases. Eight patients had received radiotherapy to the region pre-operatively. In all cases, diseased bone was macroscopically cleared from the pelvis and reconstruction performed by means of a Harrington procedure with threaded pins passed antegrade from the iliac crest 915 cases) or mesh and screws (5 cases), all reinforced with cement around which a total hip arthroplasty was performed. Mean follow-up was 16 months. Complications were broken pin (1 case), dislocation of femoral prosthesis (1) and deep venous thrombosis (1). Three patients died of their disease at a mean of 12 months from surgery. The remaining 17 patients continue to function at a satisfactory level with no patients having required revision surgery for loosening or deep infection. We believe that surgical reconstruction of the acetabulum is worthwhile and can provide these deserving patients with improvement in quality of life

During arthroplasty acetabular deficiencies could be reconstructed using different techniques. We describe our early results of acetabular reconstruction using impaction bone grafting supported by a wire mesh. This is a retrospective review of 45 patients (46 hips, 1 bilateral) who had acetabular reconstruction with impaction bone grafting and wire mesh between 1995–1999. The average follow up was 36 months (18–54 months). Mean age at operation was 70 years (41–88 years). 28 were primary (osteoarthritis) and 18 were revisions (painful aseptic loosening). Paprowsky’s classification was used to grade the defects – 44 hips: grade II, 2 hips: type III A. Containment was achieved with a wire mesh anchored with screws. The defect was filled with morcellised bone graft, which was impacted under the mesh (autograft in primary and allograft in revisions). Cemented Exeter components were used. Merle d’Aubigné Postel hip score and AAOS proforma was used during follow-up and cup migration was assessed using Nunn and Freeman’s method. Merle d’Aubigné Postel score showed improvement of at least 10 points in each patient (Charnley prefix: type A – 27 patients; type B – 10 patients; Type C – 8 patients) Mean vertical and horizontal cup migration of 2.6 mm each was seen, which was not statistically significant (at 5% level). Graft incorporation was seen in all radiographs. 32 hips showed a thin sheet of new bone over the superolateral surface of the mesh which was regarded as a sign of good graft incorporation. There were no complications specifically related to the wire mesh or screws (1 – superficial wound infection, 2-DVT, 2- dislocations treated conservatively). None of the patients required further revision surgery. We are encouraged by our early results of this method for reconstruction of peripheral acetabular rim deficiencies because it restores anatomy, biomechanics, replaces bone loss and provide a stable construct

Introduction. Trabecular titanium implants are 3D printed with a high-friction ingrowth surface that is continuous with the rest of the acetabular shell. The ability to “face-change” following optimum seating of the component allows unprecedented levels of versatility in acetabular orientation. Bolt-on augments enable rapid trialling and definitive insertion of a monobloc construct. The use of these implants has rapidly increased in the National Joint Registry over the last three years with little published outcome data. We present one of the largest studies using this material. Objectives. This study assesses the early stability, ingrowth and clinical outcome of revision acetabular reconstruction with trabecular titanium. Methods. 120 consecutive acetabular revisions were prospectively evaluated radiographically and clinically with a 2 to 5 year follow-up. Results. The indications for revision were aseptic loosening (84) infection (20), dislocation/ instability (9), metallosis (6) and impingement (1). The defects were classified as type I in 2 cases, IIA in 26, IIB in 47, IIC in 15, IIIA in 25 and IIIB in 5. External augments were used in 16 cases and face changing liners in 40 cases. Mean preoperative Oxford Hip Score was 24 (range 13–33) with a postoperative mean score of 36 (range 13–46). No patients were lost to follow-up which was from 2 to 4 years (mean 3 years). Two cases were subsequently revised for infection and two for instability. One case was revised for material failure as a result of a cross-threaded screw. There were no cases of aseptic loosening and all remaining implants appear well-integrated radiographically. Conclusions. These early results are very encouraging with excellent initial stability clinically and radiographically. The versatility of face-changing liners, multiple bearing options and bolt-on augments allows rapid and accurate reconstruction. The data support the use of this material and we will continue to report the outcome of this series

Introduction. To report the short to medium term results of acetabular reconstruction using reinforcement/reconstruction ring, morcellised femoral head allograft and cemented metal on metal cup. Methods. Single centre retrospective study of 6 consecutive patients who underwent acetabular reconstruction for revision hip surgery. The acetabulum was reconstructed using morcellised femoral head allograft and reinforcement or reconstruction ring fixed with screws. The Birmingham cup – designed for cementless fixation, was cemented into the ring in all cases. The uncemented Echelon stem with metal on metal modular head was used for reconstructing the femur. Data from our previous in-vitro study had shown good pull out strength of a cemented Birmingham cup. Results. There were 2 men and 4 women with a mean age of 75 years(57-83). Revision was performed for aseptic loosening in 2, septic loosening in 2 and peri-prosthetic fracture with loosening in 2 patients. All patients were reviewed clinically and radiographically at a mean of 36 months follow-up(range 24 - 42 months). Revision was not necessary in any patient for failure of acetabular or femoral fixation. However, 1 patient had revision to a proximal femoral replacement and constrained cup for recurrent infection and osteomyelitis at 24 months. This patient was excluded from the final analysis. The mean Harris hip score at last follow up was 79(range 70-89). Radiographic analysis revealed good graft incorporation and no signs of loosening or cup/ring migration. No dislocations or metal ion problems were recorded in this series. Conclusions. To the best our knowledge, this is the first series using cemented metal on metal cups within a reinforcement/reconstruction ring for revision hip arthroplasty. Excellent cemented fixation of the cup, manufactured for cementless fixation, was obtained at surgery with no evidence of loosening, and no dislocations at minimum 24 months follow up