Acetabular Defects and Their Treatment

Acetabular revision surgery accompanied by severe bone defects can be challenging. Innovative research in orthopedics and bioengineering has helped formulate successful techniques, instrumentation, and surgical implants to re-establish the normal anatomy of the hip. Careful preoperative planning should be the first step for reconstruction. Infection must be ruled out initially, and if there is any doubt, a hip aspiration should be performed. Imaging starts with standard radiographs of the pelvis and the affected hip; specialized radiographs (such as Judet oblique views) and more advanced imaging such as MARS CT can help better assess the extent of the bone loss. The Paprosky classification is the most commonly used system to describe and categorize the location and magnitude of bone loss. The surgical approach chosen for reconstruction should provide a wide view of the acetabulum and therefore be as extensile as necessary. Current options for reconstruction include impaction grafting and cementless implants for minor defects. For major defects, new implants such as trabecular metal augments, cup-cage constructs, or custom-made devices are available. The principal idea is to restore the anatomic position of the hip as closely as possible, and have a stable reconstruction able to withstand daily physiologic loading.