Major bone loss involving the acetabulum can be seen during revision THA due to component loosening, migration or osteolysis and can also occur as a sequela of infected THA. Uncemented highly porous ingrowth acetabular components can be used for the reconstruction of the vast majority of revision cases, especially where small to mid-sized segmental or cavitary defects are present which do not compromise stable mechanical support by the host bone for the cup after bone preparation is complete. A mechanically stable and near motionless interface between the host bone and the implant is required over the initial weeks post-surgery for bone ingrowth to occur, regardless of the type of porous surface employed. As bone deficiency increases, the challenge of achieving rigid cup fixation also increases, especially if the quality of the remaining host bone is compromised. A stepwise approach to enhanced fixation of the highly porous revision acetabular component is possible as follows:. Maximise Screw Fixation. Use of a limited number of screws in the dome only (as routinely occurs with a cluster hole design) is inadequate, except for primary arthroplasty cases or very routine revision cases with little or no bone loss and good bone quality. Otherwise an array of screws across the
The cemented acetabular component has been essentially abandoned, due to the reliable and durable fixation provided by bone ingrowth into cementless acetabular components of many different designs. A variety of porous surfaces including sintered beads, titanium fibermetal, plasma sprayed titanium, and ultraporous tantalum have been shown to result in significant osteointegration, and provide long term fixation of cementless acetabular components. New ultraporous metals will also likely prove to perform similarly, however, their advantages in the primary THA are unclear. Most currently available cementless acetabular components rely on obtaining initial “interference” or “frictional” fit provided by relative underreaming. Many designs incorporate additional features such as screws, pegs, and fins to limit implant micromotion and augment initial fixation until early tissue ingrowth occurs. “Underreaming” by more than 1 mm has been associated with incomplete component seating and increased incidence of acetabular fracture. Knowledge of the geometry of the component by the surgeon is recommended, since some designs are elliptical and have a built-in degree of interference fit. Screws used to augment acetabular fixation in the primary THA can typically be restricted to the area of the