Treatment of large acetabular defects: a surgical technique utilizing impaction grafting into a metallic mesh.

Abstract

Revision total hip arthroplasty in cases with severe acetabular bone loss is challenging. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been the treatment of choice. The current paper describes an impaction grafting into a mesh for uncontained defects in revision total hip arthroplasty. After restoring containment with a mesh fixed with small fragment screws, defects were restored using impaction grafting combined with a cemented all-polyethylene cup. Fourteen consecutive acetabular impaction graftings were performed by two surgeons. All patients had a type 3B defect according to the Paprosky classification. No re-revisions or radiographic failure was detected in the early follow-up period. Impaction grafting into a mesh is an interesting treatment option to restore bone in combined cavitary and segmental defects.