Acetabular revision with moderate-to-severe bone loss using a trabecular titanium cup-cage construct with impaction grafting.

Abstract

Introduction: Total hip arthroplasty (THA) is one of the most commonly performed procedures the last decades in the field of orthopaedics. However, there has been a subsequent increase in revision rates for various reasons with instability and aseptic loosening being the predominant ones. Revision surgeries pose many challenges to the treating orthopaedic surgeons as well as significant burdens on patients and on healthcare systems globally. After a revision procedure, in addition to the best possible functional outcomes, longer lifespan of the implants, the least possible bone loss and restoration of as much as possible of bone stock should also be of priority.

Materials & methods: A case series of 11 patients with aseptic loosening of the acetabular component having moderate-to-severe acetabular bone loss is presented. All patients were managed with a trabecular titanium cup-cage construct in conjunction with impaction of morselized allograft.

Results: This study assessed 11 patients (mean age 67.9 years) with Paprosky 2B-3B acetabular defects undergoing revision surgery (mean follow-up: 54.6 months). Functional outcomes improved significantly, including Harris Hip Score (44.8% to 80.7%), HOOS-JR (49.9% to 70.4%), and Forgotten Joint Score (13.6% to 81.8%). VAS and EQ-5D-5L scores also showed marked improvement. Logistic regression found no significant impact of age, sex, or ASA score on outcomes (p = 0.6). These results demonstrate notable functional recovery post-surgery.

Conclusions: Revision surgery for aseptic loosening of the acetabular component using a trabecular titanium cup-cage construct with morselized allograft demonstrates excellent functional improvement and patient satisfaction. The procedure is effective in managing moderate-to-severe acetabular bone loss (Paprosky 2B-3B), restoring function and quality of life. Despite the challenges associated with such revisions, these findings highlight the efficacy and reliability of this approach in addressing complex cases without being significantly influenced by patient demographics or preoperative risk factors.