Iliac Stemmed Cups: A Review of History, Indications, and Clinical Outcomes in Revision Hip Arthroplasty and Primary Severe Dysplasia

Abstract

Background: The increasing incidence of revision total hip arthroplasties (rTHAs), particularly due to failure of the acetabular components and severe bone loss, necessitates reliable surgical solutions. Iliac stemmed cups (ISCs) have emerged as effective options for managing complex pelvic defects, including Paprosky type 3A and 3B acetabular defects, severe developmental dysplasia, and selected pelvic discontinuities. This review examines the historical evolution, clinical indications, and outcomes associated with ISCs. Methods: This narrative review analyzed the historical and recent literature concerning various ISC designs. We critically assessed clinical outcomes, complication rates, and implant survival from 13 key studies. Results: ISCs have progressed significantly from initial monobloc designs to contemporary modular configurations, substantially enhancing surgical versatility and biomechanical stability. Clinical outcomes varied with reported complications such as infection, dislocation, mechanical failure, and aseptic loosening ranging from 10% to over 30%. Newer modular implants like the Sansone cup have demonstrated improved outcomes, with complication rates below 10% and five-year survival rates exceeding 95%. Conclusions: ISCs are reliable and versatile implants, particularly suited to address significant pelvic bone deficiencies. Optimal surgical techniques and careful implant selection remain essential to minimize complications and achieve favorable long-term functional outcomes, making these implants valuable tools in complex hip arthroplasty.

Keywords: Iliac stemmed cup; acetabular bone loss; developmental hip dysplasia; pelvic reconstruction; revision THA; revision hip arthroplasty.

Figure 1

Revision of acetabular cup and femoral stem: (A) Preoperative image showing acetabular cup mobilization and femoral stem subsidence. (B) Postoperative radiograph illustrating the use of an iliac cup, cancellous bone graft, and Wagner femoral stem via a posterior surgical approach, demonstrating complete bone graft integration at six months. (C) Comparative images of preoperative status and postoperative outcome at one-year FU.

Figure 2

Bilateral revision for polyethylene (PE) cup failure due to gamma-ray sterilization: (A) Radiograph demonstrating bilateral acetabular cup mobilization. (B) Computed tomography (CT) scan illustrating polyethylene protrusion into the pelvis on the right side. (C) Radiographic view post revision with a pedestal cup implant via a posterior approach. (D) One-year postoperative follow-up after left side revision. (E) Schematic illustration of the pedestal cup design by Perka and Schoellner.

Figure 3

First-generation Ring cup prosthesis: (A) Uncemented metal-on-metal Moore prosthesis (Ø 40 mm) with screw fixation. (B,C) Drill guides utilized for implantation. (D) Intraoperative lateral view demonstrating prosthesis positioning. (E) Radiographic evidence illustrating lateralization of the cup placement.

Figure 4

All-polyethylene acetabular component with a 32 mm femoral head and angled peg impacted into bone. Radiographic image demonstrates component failure associated with significant osteolysis.

Figure 5

Evolution of cone-shaped acetabular cup: (A) McMinn cone prosthesis. (B) Schoellner cup cone prosthesis (Zimmer-Biomet). (C) Stanmore cone prosthesis. (D) Integra cone prosthesis (Lépine). (E) LUMiC cone prosthesis (Implantcast).

Figure 6

Sansone modular iliac cup system: (A) Demonstration of the wide range of rotational and angular adjustments enabled by the Morse taper connection between the cup and iliac screw. (B) Ceramic-on-ceramic bearing option with hydroxyapatite (HA)-coated iliac screw. (C) Clinical application of the ISC in a revision case performed via a posterior approach (first case treated in 2009).

Figure 7

Evolution of the Medacta iliac screw cup system: (A) Comparison between the original hemispherical Mpact^® cup and the derived Iliac Screw cup. (B–D) Latest generation of the Iliac Screw Mpact^® 3D Metal design, showcasing advancements in modularity and the 3D-printed structure.

Figure 8

Acetabular cup revision for severe osteolysis in the periacetabular region and proximal femur. (A,B) The procedure was performed using the Iliac Screw Mpact^® 3D Metal cup and proximal femoral bone grafting via anterior approach. (C) Follow-up at 14 months demonstrates successful bone graft integration and stable cup fixation.

Figure 9

Surgical technique to implant the Iliac Screw Mpact^® 3D Metal cup in a patient with severe varus deformity of the femoral neck and a dysplastic acetabulum. (A–C) The model represents the patient’s position and shows the entry point for the iliac isthmus. (D) The procedure was carried out via a posterolateral approach, including a femoral shortening osteotomy to restore limb length.

Figure 10

Restoration of hip biomechanics following iliac screw cup implantation: (A) Preoperative radiograph showing high hip center and dysplastic anatomy. (B) Postoperative anteroposterior X-ray at 2-month follow-up demonstrating medialization and lowering of the hip center of rotation, enabling normal ambulation without Trendelenburg lurch. (C) Clinical outcome at 1-month follow-up showing full recovery of hip range of motion.