Cementless acetabular revision: past, present, and future. Revision total hip arthroplasty: the acetabular side using cementless implants

Abstract

Background: Acetabular revision is probably the most difficult aspect of hip reconstructive surgery. Although the majority of acetabular revisions can be performed using an uncemented hemispherical acetabular device with ancillary fixation, patients with severe acetabular deficiencies and poor bone quality require more complex alternatives for revision. The limitations of traditional cementless acetabular implants has promoted the development of improved methods of fixation and revision techniques. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimising biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results.

Purpose: This review focuses on the use of cementless implants for acetabular revision. The use of trabecular metal cups, augments, jumbo cups, oblong cups, cages, and structural grafting are also discussed.

Fig. 1

a Failed PCA acetabular component with severe polyethylene wear. b Same patient 11 years after revision with uncemented acetabular component

Fig. 2

The porous tantalum—Trabecular Metal (TM)—revision acetabular shell is a two-piece design that allows screw augmentation. Once good bone quality has been localised, a high speed burr is used to create extra holes in the TM shell, increasing the number of screws and enhancing initial cup fixation into the ilium dome and posterior column. Cementation of the liner into the shell eliminates backside motion and provides a secure bond between the porous shell and the backside of the insert

Fig. 3

a Preoperative left hip AP and lateral radiographs of a 54-year-old male with obvious acetabular migration and failure. A type IIIB deficiency was anticipated with the evaluation of the radiographs and confirmed intraoperatively. b Postoperative AP and lateral radiographs. The acetabular component was revised with a “jumbo” trabecular metal shell size of 74 mm. The medial cavitary defect required massive intraacetabular bone grafting

Fig. 4

a, b Oblique radiographs of the hip of a 78-year-old woman with multiple previous operations. Pelvic discontinuity is obvious. c Radiograph of same patient three years after surgical treatment with posterior column plating and trabecular metal revision socket. Note that discontinuity appears healed and socket seems osteointegrated