• THA failure
• THA survival
• giant cup
• hip arthroplasty
• jumbo cup
• revision arthroplasty

• Humans
• Reoperation/methods
• Reoperation/statistics & numerical data
• Male
• Female
• Acetabulum/surgery
• Arthroplasty, Replacement, Hip/instrumentation
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/methods
• Hip Prosthesis/adverse effects
• Registries
• Middle Aged
• Aged
• Prosthesis Failure
• Prosthesis Design
• Adult
• Aged, 80 and over
• Retrospective Studies
• Follow-Up Studies

• acetabular bone loss
• cages
• porous metal augments
• revision total hip arthroplasty
• triflange

• Humans
• Acetabulum/surgery
• Arthroplasty, Replacement, Hip/instrumentation
• Female
• Male
• Middle Aged
• Aged
• Hip Prosthesis/adverse effects
• Reoperation
• Follow-Up Studies
• Treatment Outcome
• Retrospective Studies
• Prosthesis Failure
• Prosthesis Design
• Porosity
• Adult
• Aged, 80 and over
• Metals
• Bone Resorption

• medical research
• outcomes research

• Humans
• Arthroplasty, Replacement, Hip/methods
• Bone Transplantation/methods
• Female
• Male
• Aged
• Reoperation
• Middle Aged
• Hip Prosthesis
• Metals
• Porosity
• Retrospective Studies
• Treatment Outcome

• Acetabular impaction bone grafting (AIBG)
• Harris Hip Score (HHS)
• Paprosky grading
• acetabulum
• implant
• prosthetic joint infection (PJI)
• revision arthroplasty
• total hip arthroplasty (THA)
• trabecular metal (TM)

• Humans
• Arthroplasty, Replacement, Hip/methods
• Reoperation/methods
• Male
• Female
• Aged
• Retrospective Studies
• Follow-Up Studies
• Hip Prosthesis
• Acetabulum/surgery
• Bone Transplantation/methods
• Middle Aged
• Prosthesis Design
• Prosthesis Failure
• Treatment Outcome
• Time Factors
• Bone Cements/therapeutic use
• Aged, 80 and over

• 3D printed models
• complex acetabular reconstruction
• pre-operative planning
• revision total hip arthroplasties

• Humans
• Acetabulum/surgery
• Arthroplasty, Replacement, Hip/methods
• Arthroplasty, Replacement, Hip/instrumentation
• Hip Prosthesis
• Female
• Male
• Aged
• Retrospective Studies
• Prosthesis Design
• Tantalum
• Middle Aged
• Tomography, X-Ray Computed
• Biomechanical Phenomena
• Reoperation
• Aged, 80 and over
• Prosthesis Failure
• Porosity

• Aged
• Female
• Humans
• Male
• Middle Aged
• Acetabulum/surgery
• Arthroplasty, Replacement, Hip/methods
• Arthroplasty, Replacement, Hip/instrumentation
• Hip Prosthesis
• Porosity
• Prosthesis Design
• Prosthesis Failure
• Reoperation
• Retrospective Studies
• Tantalum

• Arthroplasty
• Hip
• PJI
• Prosthesis-related infections
• Tantalum

• Biocompatibility
• Biomedical cellular solids
• Fatigue resistance
• Metallic materials
• Regenerative medicine
• Tissue engineering

• acetabular revision
• highly crosslinked polyethylene
• porous
• revision total hip
• uncemented

• Humans
• Arthroplasty, Replacement, Hip/adverse effects
• Hip Prosthesis/adverse effects
• Prosthesis Failure
• Prosthesis Design
• Acetabulum/surgery
• Polyethylene
• Reoperation/adverse effects
• Follow-Up Studies

• P30 AR076312 NIAMS NIH HHS
• R01 AR073147 NIAMS NIH HHS
• R01 HL147155 NHLBI NIH HHS

• Arthroplasty
• Bone resorption
• Hip
• Prosthesis failure
• Tantalum

• Bone defect
• Disc augment
• Medial acetabular wall
• Revision total hip arthroplasty

• Extracavitary iliac extended fixation
• Intracavitary iliac extended fixation
• Porous metal augment
• Revision total hip arthroplasty
• Severe bone defect

The aims of this study were to introduce the definition, indication, and surgical technique of extended ischiopubic fixation (EIF) and to investigate the early clinical, radiographic results and complications of hips revised with EIF.

Patients who underwent revision THA utilizing the technique of EIF which was defined as securing the porous metal augment >5 mm deep into the ischium and/or pubic ramus to gain adequate mechanical support and fresh host bone for bony ingrowth in a single institution from February 2015 to February 2020 were retrospectively reviewed. After applying the inclusion and exclusion criteria, a total of 30 hips (28 patients) were eligible for the study and were enrolled. Four patients were lost to follow‐up postoperatively. The data of the remaining 24 patients (26 hips) were analyzed. The patients' clinical results were assessed using of the Harris Hip Score and any complications including postoperative periprosthetic joint infection, intraoperative fracture, postoperative periprosthetic fracture, dislocation, nerve palsy, hematoma or wound complication were documented. The radiographic results were assessed with the construct stability, the position of the center of rotation, and cup orientation.

The median age of these 25 patients was 62.00 (interquartile: 54.25–68.25) years, with a median body mass index (BMI) of 22.60 kg/m² (interquartile: 21.49–25.12 kg/m²). A total of 12 (48%) patients were female. At a median duration of follow‐up of 49.16 months, 20 (80%) patients rated their satisfaction level as “very satisfied,” five (20%) were “satisfied.” The median HHS improved from 36.00 (interquartile range: 31.25–49.75) preoperatively to 81.00 (interquartile range: 74.75–88.25) at the most recent follow‐up (p < 0.001). No complications such as periprosthetic joint infection, intraoperative fracture, periprosthetic fracture, dislocation, nerve palsy, hematoma, or wound complication were identified. All constructs were considered to have obtained stable fixation. The median vertical and horizontal distance between the latest postoperative centers of rotation to the anatomic center of rotation improved from 13.62 and 8.68 mm preoperatively to 4.42 and 4.19 mm at final follow‐up (p < 0.001).

Early follow‐up of patients reconstructed with porous metal augments using the EIF technique demonstrated satisfactory clinical results with no particular complications, stable fixation, and restoration of the center of rotation.

• Acetabular reconstruction
• Extended ischiopubic fixation
• Ischial bone defect
• Lotus augment
• Porous metal augments
• Revision total hip arthroplasty

Aims: In revision total hip arthroplasty (THA), large acetabular bone defects pose challenges for surgeons. Recently, wide application of trabecular tantalum, which has outstanding biocompatibility and mechanical properties, and the development of three-dimensional (3D) printing have led to the introduction of new schemes for acetabular reconstruction. However, few studies have focused on the treatment of bone defects with customized 3D-printed titanium augments combined with tantalum trabecular cup. Thus, we aimed to evaluate the effect of this therapy in patients who underwent revision THAs.

Patients and Methods: We included 23 patients with Paprosky type III acetabular bone defects who underwent revision THA between January 2013 and June 2019. The preoperative hip rotation center and functional score were compared with those at 2–7 years (average 4.7 years) postoperatively to evaluate the midterm prognosis of our treatment choice.

Results: Postoperatively, the rotation centres of all hips were comparable with those of the contralateral hips. Hip function improved with average Harris Hip Score improved from 33.5 (22.7–40.2) to 86.1 (73.5–95.6) and average Oxford Hip Score improved from 8.3 (0–14) to 38.8 (35–48) during follow-up. One dislocation, which occurred due to extreme hip flexion within 6 weeks, was treated with closed reduction, and no recurrent dislocation occurred. No nerve injury, infection, aseptic loosening, or osteolysis were observed and no re-revision was performed in any patient.

Conclusion: Satisfactory midterm outcomes were obtained with 3D-printed titanium augment combined with tantalum cup for the treatment of acetabular defects in revision THA. Changes in the Harris Hip Score and Oxford Hip Score suggested a significant improvement in hip function.

• National Natural Science Foundation of China
• Shanghai Municipal Education Commission

• arthroplasty
• hip
• outcomes
• pelvic discontinuity
• pelvic dissociation
• revision
• treatment

There is no consensus on how to best address acetabular insufficiency. Several described techniques have a high rate of loosening and most rely on fixation to intact innominate bones. They also require extensive exposure and expensive implants. We present a novel technique for acetabular insufficiency management including discontinuity and a series with mean 6.5-year follow-up.

After exposure, a femoral neck osteotomy is made, or the femoral component is removed. Bone graft is reverse reamed into the defect, and a porous coated acetabular shell is implanted with screws for supplemental fixation. In 3-6 months, after defect healing, the femoral component is implanted. All staged total hip arthroplasties for pelvic discontinuity from 2010 to 2015 by a single provider with minimum 5-year follow-up were identified. Implant survivorship, Merle d’Aubinge, and visual analog scale scores as well as complications were recorded.

Nine patients were identified with mean 80.8-month follow-up (62-129). Merle D’Aubinge scores improved from 5.6 (4-8) to 15.3 (14-18), and Visual analog scale scores improved from 7.2 (6-9) to 0.8 (0-2). All implants were retained, and all patients were ambulatory at the terminal follow-up. There were 2 greater trochanter fractures, one calcar fracture managed with cerclage, and one patient developed heterotopic ossification.

Staged total hip arthroplasty can be used to address pelvic discontinuity with excellent short- to mid-term outcomes. This technique allows for a more limited exposure and the use of primary hip implants. Fixation is by ingrowth and does not rely on intact pelvic architecture.

• Acetabular fracture
• Pelvic discontinuity
• Protrusio
• Revision hip arthroplasty
• Staged hip arthroplasty

• Acetabular revision
• Paprosky type III bone defect
• Tantalum augments
• Titanium-coated cup

• additive manufacturing
• bone tissue engineering
• clinical application
• porous tantalum
• surface modification

• 81860477 National Natural Science Foundation of China
• 81860480 National Natural Science Foundation of China

• acetabular defects
• hip center of rotation
• osseointegration
• osteolysis
• revision hip arthroplasty
• trabecular metal augments

Management of acetabular defects in total joint reconstruction can be challenging. Various algorithmic approaches have been developed, with some recommending using posterosuperior acetabular buttress augments for severe defects. The superior gluteal nerve lies in close proximity to their application, and damage to it results in deterioration of hip stability and gait mechanics. There has been investigation into the relationship of the superior gluteal nerve to various anatomic points. To our knowledge, no study exists examining the relationship between the acetabular rim and the superior gluteal nerve for the application of these particular devices.

Ten adult cadaver specimens were examined. A reproducible technique in relation to the typical placement of a buttress augment was used. From a distance of 20 millimeters (mm) lateral to the greater sciatic notch, the distance from the superior gluteal nerve to the posterosuperior acetabular rim was measured.

The average distance between the posterosuperior acetabular rim and the superior gluteal nerve was found to be 52 mm, ranging from 48 mm to 60 mm.

With proprietary acetabular augments measuring up to 68 mm in length, the superior gluteal nerve could be at substantial risk with placement of these devices. Surgeons should take great care with dissection for and intraoperative placement of these devices, and particularly strive for optimized prosthetic hip stability to mitigate the risk of dislocation from nerve injury. To our knowledge, this study is the first of its kind and provides valuable anatomic and operative knowledge during these highly complex cases.

• Acetabular defect
• Augment
• Buttress
• Revision total hip arthroplasty
• Superior gluteal nerve

• acetabular bone loss
• porous metal augments
• revision total hip arthroplasty

• Acetabular defect
• Augmentation technique
• Restoration of the center of rotation

• Acetabulum/pathology
• Acetabulum/physiopathology
• Acetabulum/surgery
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/methods
• Bone Screws
• Female
• Hip Prosthesis
• Humans
• Osseointegration
• Polyethylene
• Prosthesis Design
• Plastic Surgery Procedures/methods
• Reoperation/methods
• Rotation
• Treatment Outcome

• Acetabular revision
• long-term follow-up
• titanium cage reconstruction

• Spinopelvic alignment
• dislocation
• hip-spine
• pelvic tilt
• total hip arthroplasty

Paprosky type IIIB acetabular bone defects are very difficult to reconstruct. For severe defects, we developed our own cup-on-cup technique. We defined the tantalum metal (TM) revision shell with the peripheral titanium ring removed as a TM-cup augment and the cementless hemispherical acetabulum component combined with a TM-cup augment as the cup-on-cup technique.

To report the short-term results of patients with type IIIB acetabular bone defects reconstructed using the cup-on-cup technique.

We retrospectively reviewed six patients (six hips) with a mean age of 59 years who underwent acetabular reconstruction using our cup-on-cup technique between January 2015 and January 2017. All acetabular bone defects were classified as type IIIB without pelvic discontinuity using the system of Paprosky. All patients were followed both clinically and radiographically for a mean duration of 42 mo.

The mean Harris hip score improved from 32.4 pre-operatively to 80.7 at the last follow-up. The mean vertical position of the hip rotation centre changed from 60.9 mm pre-operatively to 31.7 mm post-operatively, and the mean horizontal position changed from 33.6 mm pre-operatively to 38.9 mm post-operatively. Greater trochanteric migration after extended trochanteric osteotomy occurred in one of six hips at 3 mo. There was no evidence of component migration at the last follow-up.

The short-term results suggest that our cup-on-cup technique could be considered an effective management option for Paprosky type IIIB acetabular bone defects without pelvic discontinuity.

• Total hip arthroplasty
• Trabecular metal
• Cup-on-cup
• Bone defect

In this study, we described a positioner which allows a combination of preoperative plan and intraoperative insertion of the cup to improve the reconstruction of the rotation center of the hip.

A retrospective study was conducted on 32 consecutive patients (group A) using this positioner and 40 consecutive patients (group B) using conventional method; radiological parameters and clinical measurements before operation and at last follow-up were collected and evaluated.

Group A had a reconstructed center of rotation (COR) that was 0.19 mm closer to the anatomic COR in height (P < 0.005), compared with group B with 3.45 mm vertical dislocation. There were no statistically significant differences in the horizontal displacement between the two groups. The accuracy of cup inclination was 42.14 ± 3.57 in the group A and 38.73 ± 7.65 in the group B (P = 0.015). The accuracy of cup anteversion was 14.82 ± 1.44 in the group A and 13.08 ± 5.95 in the group B (P = 0.082). All cups in the group A were radiologically stable, while one cup in the group B was radiologically unstable and was successfully treated with second-stage revision. Both of the groups obtained a higher mean postoperative Harris Hip Score.

Utilizing this positioner helps to restore the COR position more precisely and provides satisfactory radiological and clinical outcomes in the short term, and more studies are required before its widespread adoption for complicated cases.

• 3D printing
• Computer-assisted
• Positioner
• Rotation center
• Total hip arthroplasty

• Acetabular defects
• Acetabular revision surgery
• Hip revision surgery
• Paprosky classification
• Pelvic discontinuity

• Acetabuloplasty/methods
• Acetabulum/surgery
• Aged
• Arthroplasty, Replacement, Hip
• Hip Prosthesis
• Humans
• Middle Aged
• Observational Studies as Topic
• Outcome Assessment, Health Care
• Prosthesis Design
• Prosthesis Failure
• Publication Bias
• Reoperation/methods
• Reoperation/statistics & numerical data

• augment
• biomechanical reconstruction
• center of rotation
• head-cup difference
• jumbo cup
• revision total hip arthroplasty

• Ganz reinforcement ring
• THA
• acetabular revision
• long-term follow-up
• revision total hip arthroplasty
• total hip arthroplasty

• Acetabulum/diagnostic imaging
• Acetabulum/pathology
• Acetabulum/surgery
• Adult
• Aged
• Allografts
• Arthroplasty, Replacement, Hip/methods
• Bone Transplantation
• Female
• Follow-Up Studies
• Hip Joint/diagnostic imaging
• Hip Prosthesis
• Humans
• Male
• Middle Aged
• Osseointegration
• Prosthesis Failure
• Reoperation
• Retrospective Studies
• Tantalum

• Acetabular defect
• hip arthroplasty
• revision
• trabecular metal

• Acetabular reconstruction
• Acetabular reinforcement devices
• Inferior margin of the acetabulum
• Revision total hip arthroplasty
• Structural allograft

• Acetabulum
• Allograft
• Hip arthroplasty
• Revision

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Arthroplasty, Replacement, Hip/adverse effects
• Arthroplasty, Replacement, Hip/instrumentation
• Arthroplasty, Replacement, Hip/statistics & numerical data
• Child
• Female
• Hip Prosthesis
• Humans
• Joint Diseases/surgery
• Male
• Metals
• Middle Aged
• Proportional Hazards Models
• Prosthesis Design
• Prosthesis-Related Infections/epidemiology
• Registries
• Reoperation
• Sweden
• Young Adult

• arthroplasty
• augments
• hip
• metal
• revision
• trabecular

This study is aimed at evaluating the fixation of trabecular metal wedges in patients who underwent revision of total hip arthroplasty with large acetabular bone defects.

The radiographs of 19 patients (21 hips), who underwent revision of total hip arthroplasty using trabecular metal wedges from September 2010 to December 2014 were evaluated. This study included only cases of Paprosky 3A and 3B. Preoperative and postoperative images were analyzed. Non-fixation of the implant was defined by the presence of angular variation of the component higher 10 degrees or displacement greater than 6 mm. Patients with follow-up times of less than 24 months or who did not attend the last two appointments were excluded from the study.

The mean follow-up time was 39.4 months (25–61). Fixation was achieved in all cases despite its complexity. There was only one case of dislocation that was treated with open reduction. One case developed infection, and was surgically approached on two occasions, with extensive debridement and intravenous antibiotics following protocol, with good evolution.

The implanted trabecular metal wedges showed excellent results in the short- and medium-term and may represent another option in the reconstruction of large acetabular defects, sometimes replacing bone reconstruction that uses bone tissue banks or autologous graft.

• Acetabulum
• Hip arthroplasty
• Prostheses and implants

Few reconstructive techniques are available for patients requiring complex acetabular revisions such as those involving Paprosky type 2C, 3A and 3B deficiencies and pelvic discontinuity. Our aim was to describe the development of the patient specific Triflange acetabular component for use in these patients, the surgical technique and mid-term results. We include a description of the pre-operative CT scanning, the construction of a model, operative planning, and surgical technique. All implants were coated with porous plasma spray and hydroxyapatite if desired.

A multicentre, retrospective review of 95 complex acetabular reconstructions in 94 patients was performed. A total of 61 (64.2%) were female. The mean age of the patients was 66 (38 to 85). The mean body mass index was 29 kg/m² (18 to 51). Outcome was reported using the Harris Hip Score (HHS), complications, failures and survival.

The mean follow-up was 3.5 years (1 to 11). The mean HHS improved from 46 (15 to 90) pre-operatively to 75 (14 to 100). A total of 21 hips (22%) had at least one complication with some having more than one; including dislocation (6%), infection (6%), and femoral complications (2%). The implant was subsequently removed in five hips (5%), only one for suspected aseptic loosening.

The Triflange patient specific acetabular component provides predictable fixation with complication rates which are similar to those of other techniques.

Cite this article: Bone Joint J 2018;100-B(1 Supple A):50–4.

• Acetabular component failures
• Acetabular reconstruction
• Complicated acetabular revision
• Patient specific Triflange
• Pelvic defects

• acetabular bone deficiency
• outcomes
• revision arthroplasty
• structural allograft
• total hip arthroplasty

• Acetabular periprosthetic fractures
• Bone loss
• Hip revision surgery
• Outcomes
• Paprosky acetabular classification
• Tantalum

The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.

• Arthroplasty
• Hip
• Hip prosthesis
• Reoperation
• Replacement