Evaluation and Management of Acetabular Bone Loss in Revision Total Hip Arthroplasty: A 10-year Update

Acetabular bone loss continues to be one of the most complex and challenging scenarios facing the orthopaedic surgeon. Preoperative planning and classification systems essentially have remained the same, with the Paprosky classification still being the most commonly used. Careful radiological assessment with well-defined criteria can accurately diagnose acetabular bone loss patterns with an associated chronic pelvic discontinuity before surgery. The use of cemented reconstruction techniques has declined, and contemporary practice trends have involved the increasing use of highly porous hemispherical shells in conjunction with modular porous metal augments, which can successfully treat most acetabular revisions. Noncemented treatment options for the management of acetabular bone loss during revision include conventional porous/modular highly porous hemispherical implants, nonmodular highly porous implants with cementable acetabular liners, cup-cage reconstruction, oblong cups, and triflange reconstruction. These options can be combined with modular porous metal augments, structural allografts, impaction grafting, or reconstruction cages. Acetabular distraction is a newer technique for chronic pelvic discontinuity, which is used in conjunction with off-the-shelf revision acetabular shells and modular porous metal augments. This review is an update over the past decade, highlighting studies with mid to long-term follow-up, and presents the advantages, disadvantages, and principles associated with each of the most commonly used reconstructive techniques.