High placement of porous-coated acetabular components in complex total hip arthroplasty

Type III Acetabular Defect Revision With Bilobed Components

“…In the senior author's (JTM) experience, the loosening rate for combined cavitary and segmental pelvic defects, American Academy of Orthopaedic Surgeons Type III, reconstructed by hemispheric cups and structural bone grafts have been high (33%) [20]. This is similar to reported rates of 24% to 47% [10,12,15,17,24,25,27].…”

“…Restoration of the hip center potentially will improve leg length differences, decrease limp, and help reestablish and maintain hip stability, mechanics, and range of motion [2,27]. Superolateral placement of the acetabular component theoretically can increase joint contact forces and subsequent wear rates causing early loosening and higher failure rates [8].…”

“…the pelvis [25,27]. Although avoiding the use of a structural bone graft and cement, both methods fail to restore the hip center to a more anatomic position [2] and jumbo cups risk additional bone loss from the anterior and/or posterior column.…”

Acetabular revision with allograft bone: 103 revisions with 3 reconstruction alternatives, followed for 0.3–13 years

“…Using bulk femoral allografts and cemented polyethylene cups, Harris and his group reported cumulative survival rates of 100% at 3.6 years, 54% at 8 years, and only about 32% at 13 years Harris 1990, Kwong et al 1993). Concern about the long-term durability of bulk femoral head allografts prompted some authors to recommend placing the cup at a high hipcenter to avoid the use of bulk allografts (Rusotti andHarris 1991, Schutzer andHarris 1994). High placement of acetabular components in revision THR, however, is thought to be an option only in the elderly patient with a low activity level, because at a follow-up period of 3 years, this tech- nique was associated with high loosening rates, with 25% in the femur and 5% in the acetabulum (Kelley 1994).…”

Acetabular Cage Survival and Analysis of Factors Related to Failure

“…Specifically, the goals of restoring or preserving pelvic bone stock, placing the acetabular component in the correct anatomic position, optimizing joint stability, equalizing leg lengths, and achieving stable fixation are not as readily achieved in such a situation [16]. Different ways of treating this problem have been proposed, including acceptance of a high hip center [28,30], cementing a cup onto structural bone graft [22], or using a bilobed cup [8], a custom triflanged cup [9,19], a jumbo cup [11,40], a trabecular metal cup with augments [20], or a reconstructive cage [5,24]. Despite the number of proposed solutions, none appear clearly superior over others, and pelvic deficiencies continue to be a perplexing problem.…”