Reconstructing Pelvic Discontinuity and Severe Acetabular Bone Loss in Revision Hip Arthroplasty with a Massive Allograft and Cage.

Abstract

The use of a massive allograft along with an antiprotrusio cage for the treatment of large periprosthetic acetabular defects can restore structural integrity to the pelvis and provide durable revision-free survival. Perform an extensile approach to the acetabulum. Ensure that the appropriate tools are available for removal of the existing acetabular component. It is important to remove fibrous tissue around the acetabulum to get to healthy bleeding bone. It is important to remove all of the native cartilage from the graft to allow for osseous ingrowth potential. Ensure that the graft properly fits within the acetabular defect. It is important to stabilize the bulk allograft to the pelvis before reaming. Impact the cage implant into position and secure it to the pelvis with as many screws as necessary to obtain a secure implant. Cement the polyethylene cup in the proper orientation and reduce the hip. We reviewed 72 cage constructs in 68 patients at a mean follow-up of 5.1 years (range, 1.2 to 10.7 years)³.