Surgical Pearls for Acetabular Revision

    Dr. Scott Sporer and Dr. David Lewallen offer their top tips and tricks for removing a well-fixed acetabular component and then reconstructing the acetabulum to account for bone loss.

    When revising a total hip arthroplasty, the well-fixed acetabular component needs to be removed in cases of:

    • Aseptic loosening
    • Infection
    • Instability
    • Poor track record of implant survival
    • Inability to exchange the polyethylene liner

    But, according to Scott Sporer, MD, the acetabular component can be retained if it is:

    • Mechanically stable
    • Well positioned
    • Able to accept a new polyethylene liner

    Dr. Sporer also will retain the component to avoid removing a well-fixed cementless component and if the component has periacetabular osteolysis.

    During his session at ICJR’s annual Winter Hip & Knee Course, Dr. Sporer showed a series of videos demonstrating techniques for removing different types of well-fixed cups.

    Dr. Sporer’s presentation can be found here.

    With acetabular revision, the goal is to maximize support for the revision cup on intact host bone. In most cases, this can be accomplished with a large, uncemented cup and cancellous graft.

    But sometimes, there is so much acetabular bone loss that adequate fixation with a hemispherical cup is impossible. This occurs with:

    • Irregular defects
    • Major bone deficiency
    • Poor bone stock
    • Fractures or nonunions
    • Irradiated bone

    In those cases, David Lewallen, MD, will use augments and cages as modular adjuncts to the hemispherical cup.

    Also speaking at the Winter Hip & Knee Course, Dr. Lewallen provided technical tips for using augments and cages, as well as showed videos of his technique for using the products.

    Dr. Lewallen’s presentation can be found here.