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

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

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

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

Acetabular component loosening with associated bone loss is a challenge in revision hip arthroplasty. Trabecular Metal (TM) by Zimmer Biomet has been shown to have greater implant survivorship for all-cause acetabular revision in small cohort retrospective studies. Our study aims to review outcomes of acetabular TM implants locally.

Acetabular reconstruction of extensive bone defect is troublesome in revision total hip arthroplasty (rTHA). Kerboull or Kerboull type reinforcement acetabular device with allobone grafting has been applied since 1996. Clinical results of the procedure were evaluated. Patients. One hundred and ninety-two consecutive revision total hip arthroplasties were performed with allograft bone supported by the Kerboull or Kerboull type reinforcement acetabular device from 1996 to 2009. There were 23 men and 169 women. Kerboull plates were applied to 18 patients, and Kerboull type plates to 174. The mean follow up of the whole series was 8 years (4–18years). Surgical Technique. The superior bone defect was reconstructed principally by a large bulky allo block with plate system. Medial bone defect was reconstructed by adequate bone chips and/or sliced bone plates. After temporally fixation of bulky bone block with two 2.0mm K-wires, it was remodeled by reaming to fit the gap between host bone and plate, followed by fixation to the iliac bone by screws. Finally, residual space of the defect between host bone and the fixed plated was filled up with morselized cancellous bones, bone chips, and/or wedged bony fragments with impaction. This method was sufficiently applicable to AAOS Typeâ�, II, and III bone defects. In case of AAOS Typeâ�£, the procedure was also available after repairing discontinuation between distal and proximal bones by reconstrusion plate or allografting with tibial bone plates or sliced femoral head. Results. Nine patients (4.7%) required revision surgery (infection 5, breakage 3, and malalignment 1). The plate breakage was observed in 8 joints (4.2%). Three patients had no symptoms after the breakage. Three required revision, but the other cases were carefully observed without additional surgical intervention. Ten-year survival rate by Kaplan-Meier method was 96.6% when the endpoint was set revision by asceptic loosning. Conclusions. This study indicated that acetabular allograft reconstructions reinforced by Kerboull or Kerboull type acetabular device were able to recover bone stock with anatomic reconstruction of femoral head center, thus providing satisfactory clinical results in middle term period

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

Between 1993 and 2003, 67 consecutive revision total hip arthroplasties were performed in 65 patients, including 52 women and 13 men, using hydroxyapatite (HA) granules supported by a Kerboull-type reinforcement acetabular device. The average age at the time of index surgery was 68.6 years. The Acetabular bone loss according to the American Academy of Orthopaedic Surgeons (AAOS) system was type II for 7 hips, type III for 58 hips, and type IV for one hip. The Kerboull-type acetabular reinforcement device used was Kerboull Cross Plate in 18 hips and KT Plate in 49 hips. HA granules of sizes 0.9 to1.2 mm (G4) and 3.0–5.0 mm (G6) were mixed in a ratio of 1:1. Autografts were used to reconstruct the major segmental defects in 7 hips. At the time of this study 30 hips were lost of follow-up. Among 30 hips 22 hips were lost of follow-up because of the death of the patients. The remaining 37 hips were examined clinically and radiologically. The mean follow-up period of the series was 12.8 years. Complications were examined and clinical evaluation was done using Japanese Orthopaedic Association (JOA) hip score. The criterion for loosening of the acetabular component was cup migration exceeding 3 mm or angular rotation exceeding 3 degrees or breakage of the device. Among the entire series of 67 hips postoperative complications included dislocation in 3 hips, infection in 2 hips and revision in 4 hips. Two hips were revised for loosening and the other two hips were revised for infection. The JOA hip score increased from a mean value of 48.0 preoperatively to 76.8 at the last follow-up. Radiologically 5 hips were loose. Two hips among them were revised. Survival rate of the acetabular component at 10 years was 97.1% using acetabular revision for loosening as the end point and 90.6% using radiological loosening as the end point. Acetabular reconstruction with HA granules and a Kerboull-type acetabular device provided satisfactory clinical and radiographic results at 12.8 post-operative years

40 patients affected by primary and secondary acetabular bone stock defect that were operated using cemented and cementless hip replacement.

Bone defect was classified according to American Academy of orthopaedic surgery, different types of bone graft techniques and metal reinforcement were used.

Geometrical position of the acetabular component, cup integration, hip center and graft interposition were assessed, 95% of the cups were in the desired position with graft incorporation and remodeled with one case of partial sciatic affection, most of reconstructions in primary hips were done with cementless cups but most of reconstructions in defects following loosening were treated by cemented cups.

The results depend on the stability of the graft, cementing technique as well as cup position.

Background

Failed ingrowth and subsequent separation of revision acetabular components from the inferior hemi-pelvis constitutes a primary mode of failure in revision total hip arthroplasty (THA). Few studies have highlighted other techniques than multiple screws and an ischial flange or hook of cages to reinforce the ischiopubic fixation of the acetabular components, nor did any authors report the use of porous metal augments in the ischium and/or pubis to reinforce ischiopubic fixation of the acetabular cup. The aims of this study were to introduce the concept of extended ischiopubic fixation into the ischium and/or pubis during revision total hip arthroplasty [Fig. 2], and to determine the early clinical outcomes and the radiographic outcomes of hips revised with inferior extended fixation.

Aims

Severe, superior acetabular bone defects are one of the most challenging aspects to revision total hip arthroplasty (THA). We propose a new concept of “superior extended fixation” as fixation extending superiorly 2 cm beyond the original acetabulum rim with porous metal augments, which is further classified into intracavitary and extracavitary fixation. We hypothesized that this new concept would improve the radiographic and clinical outcomes in patients with massive superior acetabular bone defects.

INTRODUCTION

Since July 2008 we are experimenting a new cup with iliac screw fixation, developed on the idea of Ring and Mc Minn. Iliac fixation is permitted by a polar screw of large diameter, coated by HA, which allows a compression to bone and a firm primary stability. Moreover it's possible to increase primary stability with further smaller peripherals screws. We present this new cup and report the preliminary results.

Complex acetabular reconstruction for oncology and bone loss are challenging for surgeons due to their often hostile biological and mechanical environments. Titrating concentrations of silver ions on implants and alternative modes of delivery allow surgeons to exploit anti-infective properties without compromising bone on growth and thus providing a long-term stable fixation. We present a case series of 12 custom acetabular tri-flange and custom hemipelvis reconstructions (Ossis, Christchurch, New Zealand), with an ultrathin plasma coating of silver particles embedded between layers of siloxane (BioGate HyProtect™, Nuremberg, Germany). At the time of reporting no implant has been revised and no patient has required a hospital admission or debridement for a deep surgical site infection. Routine follow up x-rays were reviewed and found 2 cases with loosening, both at their respective anterior fixation. Radiographs of both cases show remodelling at the ilium indicative of stable fixation posteriorly. Both patients remain asymptomatic. 3 patients were readmitted for dislocations, 1 of whom had 5 dislocations within 3 weeks post-operatively and was immobilised in an abduction brace to address a lack of muscle tone and has not had a revision of their components. Utilising navigation with meticulous implant design and construction; augmented with an ultrathin plasma coating of silver particles embedded between layers of siloxane with controlled and long-term generation of silver ion diffusion has led to outstanding outcomes in this series of 12 custom acetabular and hemipelvis reconstructions. No patients were revised for infection and no patients show signs of failure of bone on growth and incorporation. Hip instability remains a problem in these challenging mechanical environments and we continue to reassess our approach to this multifaceted problem

Introduction. Acetabular fractures management is controversial since, despite a good anatomical reduction, clinical outcome is not satisfactory very often and the probability of a total hip arthroplasty (THA) is high. Surgical treatment include long operating times, large approach, blood loss, neural and muscle damage, and a high risk of failure and secondary osteoarthritis related to bone necrosis, cartilage damage, and bone loss. We hypothesized that the acetabular fracture management affected the clinical and radiological outcome of THA after posttraumatic arthritis. Materials and Methods. We compared 49 patients (49 hips) initially treated conservatively followed some months later by THA in conjunction with acetabular reconstruction (group 1); and 29 patients (29 hips) who had undergone THA after a failed osteosynthesis (group 2). There were more associated fractures according to Letournel in group 2. The mean age was 59.3±15.8 years for group 1 and 52.9±15.2 years for group 2. The mean delay between fracture and THA was 75.4±5 months for group 1 and 59.4±5 for group 2. The mean follow-up was 11.7 in group 1 and 10.2 in group 2. Preoperative bone defect was similar. We used bone autograft in 13 hips (26.5%) in group 1 and four (13.6%) in group 2. We used acetabular reconstruction plates in 2 hips with a pelvic discontinuity in group 1. Complications, clinical outcome according to Harris Hip Score, and radiological reconstruction were compared. Two-way ANOVA with repeated measures were used for comparison. Results. There were 5 cups revised for aseptic loosening in group 1 and 2 in group 2. The cumulative probability of not having a cup revision at 16 years was 90.6% (95% confidence interval (CI) 78,1 to 100) for group 1 and 94.1% (95% CI 86.5 to 100) for group 2 (p=0.76). There were 4 sciatic palsies in group 2, 4 of which developed after trauma and 2 after osteosynthesis. There were no infections. Although pre-operative clinical score was better in group 1, post-operatively at latest follow-up there were no differences. The radiological reconstruction was better in group 1 for version angle (p=0.03) and abductor lever arm (p=0.02). The change from the pre- to post-operative situation was greater in group 2 for the latter (Delta value, p=0.002). The rate of post-operative heterotopic ossifications was greater in group 2 (p=0.04). Conclusions. Long-term clinical and radiograph results are good in patients who underwent THA after a complex acetabular fracture, however, primary THA in conjunction with acetabular reconstruction had a lower number of complications and a better radiographic acetabular reconstruction than a THA after failed osteosynthesis

Introduction. Reinforcement ring with allograft bone is commonly used for acetabular reconstruction of bone defects because it can achieve stable initial fixation of the prosthesis. It is not clear whether the allograft bone can function as a viable host bone and provide long-standing structural support. The purpose of this study was to assess to long-term survival of the reinforcement rings and allograft bone incorporation after acetabular revisions. Methods. We retrospectively reviewed 39 hips (37 patients) who underwent reconstruction of the acetabulum with a Ganz reinforcement ring and allograft bone in revision total hip arthroplasty. There were 18 females and 19 males with a mean age of 55.9 years (35–74 years). The minimum postoperative follow-up period was 10 years (10∼17 years). We assessed the acetabular bone defect using the Paprosky's classification. We determined the rates of loosening of the acetabular reconstructions, time to aseptic loosening, integration of the allograft bone, resorption of the allograft bone, and survival rate. Aseptic loosening of the acetabular component was defined as a change in the cup migration of more than 5 mm or a change in the inclination angle of more than 5° or breakage of the acetabular component at the time of the follow-up. Graft integration was defined as trabecular remodelling crossing the graft-host interface. Resorption of the allograft bone was classified as minor (<1/3), moderate (1/3–1/2) or severe (>1/2). Kaplan-Meier survivorship analysis was performed for aseptic loosening of the acetabular component. The results. The acetabular bone defects were classified as follows: 8 type II hips (4 type IIB, 4 type IIC), and 31 type III hips (17 type IIIA, 14 type IIIB). Fourteen (35.9%) of 39 hips was defined as aseptic loosening of an acetabular component. Loosening was more frequent in type IIIB (57.1%) than in type IIIA hips (29.4%). Mean time to aseptic loosening of the acetabular reconstructions was 6.3 years in type IIIA and from 5 years in type IIIB defects, respectively. Allograft bone incorporation was satisfactory in 66.7% of hips. There was minor bone resorption in 14.3% and moderate bone resorption in 10.2%. In 9 hips (23.1%), severe resorption of the allograft bone was observed and early component loosening was observed in these cases. The survival rate of acetabular component at 10 years of follow-up was 63.6% (95% confidence interval, 49–77%) with aseptic loosening as endpoints. Conclusions. The long-term survival rate of acetabular revision using the reinforcement ring and allograft bone in the reconstruction of severe acetabular bone defects was unsatisfactorily low due to loosening of acetabular components. Because of unfavorable graft incorporation into a host bone, an alternative component and structural support may be employed in the reconstruction of severe acetabular bone defects

The moderator will lead a structured panel discussion that explores how to manage challenges commonly found in the multiply revised hip. Topics covered will include: (1) Preferred exposure in multiply operated hip (when to use ETO, when not to use ETO, which type of ETO to use); (2) Implant removal: technical tips for cup removal; (3) Bone loss: favored acetabular reconstruction in severe bone loss (when to use cancellous graft, bulk graft, metal augments); favored acetabular reconstruction methods for different categories of bone loss; favored femoral reconstruction methods for the multiply operated hip; (4) Favored methods of preventing/managing hip instability (large head, dual mobility, constrained implants) in multiply operated hip; (5) When to accept resection arthroplasty as definitive procedure

The moderator will lead a structured panel discussion that explores how to manage challenges commonly found in the multiply revised hip. Topics covered will include: (1) Preferred exposure in multiply operated hip (when to use ETO, when not to use ETO, which type of ETO to use); (2) Implant removal: technical tips for cup removal; (3) Bone loss: favored acetabular reconstruction in severe bone loss (when to use cancellous graft, bulk graft, metal augments); favored acetabular reconstruction methods for different categories of bone loss; favored femoral reconstruction methods for multiply operated hip; (4) Favored methods of preventing/managing hip instability (large head, dual mobility, constrained implants) in multiply operated hip; (5) When to accept resection arthroplasty as definitive procedure

Acetabular defects often result from osteolysis with or without component loosening. The goals of acetabular reconstruction in the face of significant rim or column deficiencies are to create a stable acetabular construct, which will facilitate acetabular component biologic fixation and long-term stability. Four reconstructive techniques have emerged to treat these defects: 1) Large allografts, 2) Cup / Cage constructs, 3) Metallic augments and uncemented hemispherical cups, and 4) Triflange custom implants. While all of these techniques have demonstrated success, we have elected to pursue triflange implants to improve fixation on host bone, allow modular liner options, facilitate enhanced fixation surfaces, match patient complex geometries, opportunity to utilise locking screws, and possibly reduce surgical operative time. Furthermore, screw paths and lengths can be planned pre-operatively along with custom pelvic model generation which makes surgical exposure and reconstructive more understandable. Multiple studies have shown excellent survivorship in series of the most challenging acetabular reconstructions

The main causes of total hip arthroplasty (THA) revisions are loosening and instability. Use of a dual mobility cup cemented in a acetabular reconstruction cage device limits the risk of instability and does not hinder the acetabular fixation during THA revisions. The objective of this study was to analyse a retrospective series of 123 THA revisions with antiprotusio cage and dual mobility socket. Patients and methods: At a mean follow-up of 10 years, we analysed a continuous series of 123 revisions using a reconstruction device (87 Kerboull cross-plates, 12 Burch-Schneider antiprotrusio cages, 24 custom-fit Novae ARM cages associated in all cases with a Novae Stick dual mobility cup cemented into the cage). There were 80 women and 43 males. The mean age at the surgery was 69.2 years old. PMA score increased from 9.6 +/− 3.06 preoperatively to 14.2 +/− 2. at the follow-up. 9 early dislocations occurred and one late dislocation. At the last follow-up, the X-rays showed nine hardware failures, including one cross-plate fracture, one hook fracture, and one flange fracture. Analysis of the radiological position of the cup showed a mean lowering of 13 mm and a 7 mm lateralisation compared to the preoperative position. 2 revisions for aseptic loosening and 3 for septic loosening were performed. This study confirms the advantage of dual mobility cups during acetabular reconstruction cemented in antiprotrusio cages as a way to limit, without eliminating, the risk of dislocation. Therefore cemented fixation of dual mobility cups in cages appears to be a reliable short-term option