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Purpose: The management of severe acetabular bone deficiency and a stable femoral stem can be a challenging problem in revision hip surgery. Replacement of both the acetabular and femoral component in elderly patients can increase perioperative risks without the certainty of a better functional outcome. We report the long-term outcome of reinforcement rings in isolated acetabular revision to determine whether this procedure allows hip function restoration and implant longevity. Methods: A retrospective study was conducted to evaluate the long-term results of isolated acetabular revision in thirty patients with a mean age of 70.6 years. 16 patients (16 hips) received an acetabular reinforcement ring, and 14 patients received a reconstruction cage. Acetabular defects were classified as Paprosky Type II in 16 cases and Type III in 14 cases. The mean follow-up was 11.3 years (range 10–15 years). Results: Radiographic signs of loosening were found in 9 cases (30%). 4 cases (13.3%) with severe osteolysis and implant migration underwent further revision surgery. All 30 unrevised femoral stems were considered stable. 1 (3%) early dislocation, was conservatively treated. Clinical assessment showed a significantly improved mean Harris Hip Score from 45.1 points preoperatively to 85.4 at the latest follow-up (p < 0.05). The 15-year survival rate was 86.7%. Conclusions: Our long-term results showed that in selected patients, isolated acetabular revision with rings or antiprotrusio cages represents a reasonable surgical technique for the management of severe acetabular bone loss. However, concerns about the high radiographic loosening rates are possibly related to low bone ingrowth compared to new porous implants. [ABSTRACT FROM AUTHOR]

Background: In young patients with osteonecrosis of the femoral head (ONFH), short-stem total hip arthroplasty (THA) could allow a potential advantage in preserving metaphyseal bone-stock, when revision surgery might become necessary. However, only a few studies have evaluated the outcome of short-stem THAs in ONFH. We reviewed the prospectively collected data of a cementless partial neck-retaining short-stem with ceramic-on-ceramic bearings in ONFH patients.Methods: Thirty patients (37 hips) younger than 60 years (mean age at surgery, 51.5 years) underwent THA with the NANOS® stem (Smith and Nephew, Marl, Germany) from January 2006 to December 2012. All patients received a 32-mm or 36 mm ceramic femoral head. Harris hip score, WOMAC and UCLA activity score were recorded. Postoperative radiographs were evaluated for bone-implant fixation and osteolysis. Further analysis correlated clinical findings with implants characteristics and patient demographics at mean 5.6 years' follow-up (range, 3-10 years).Results: The clinical and functional results improved significantly (p < 0.001). At latest follow-up, mean HHS, WOMAC, and UCLA activity scores were 90 (range, 71-100), 94 (range, 76-100), and 6.3 (range, 4-10) points, respectively. The diameter of the femoral head did not influence the clinical outcome (p = 0.661). All hips showed bone ingrowth fixation of the acetabular and femoral components. No patients showed osteolysis. No revision for any reason was performed during the study period.Conclusions: The excellent clinical results and fixation pattern at mean 5.6 years' follow-up reveal this implant as a reliable option in advanced stage of ONFH either. Further investigations are crucial to determine the long-term durability and to assess whether the association of ceramic-on-ceramic bearings, can be useful to achieve longer survivorship and lower complications rates.Trial Registration: Registry number: ISRCTN 91336248 ; date of registration: 04/07/2017. [ABSTRACT FROM AUTHOR]