Acetabular Component Revision in TotalHip Arthroplasty. Part II: Management ofMajor Bone Loss and Pelvic Discontinuity

摘要

Use of structural bone graft and/or reconstruction cagedevices in acetabular revisions with major bone losshas the advantages of providing a stable construct atthe anatomical hip center of rotation and, theoretically,reconstituting bone stock. When the structural graftsupports more than 50% of the acetabular component,a reconstruction cage device spanning ilium to ischiumshould be used to protect the graft and provide struc-tural stability. Recent introduction of trabecular metalcups and augments and custom triflanged acetabularcomponents has increased the potential for biologicalfixation and long-term stability of revision constructs.Longer follow-up of these reconstructions is needed.Revisions with pelvic discontinuity and major bone losshave a high failure rate and require techniques eitherto reduce and plate the discontinuity or to distract thediscontinuity to achieve long-term stability.