VIDEO TECHNIQUE: Managing Acetabular Defects in Revision THA

    Revision total hip arthroplasty (THA) calls for an MIS approach – that is, maximally invasive surgery, according to Wayne G. Paprosky, MD, from Rush University Medical Center.

    This is no time for a small incision, he told attendees at ICJR’s instructional course on joint replacement at the 9th Congress of the Chinese Academy of Orthopaedic Surgeons. The incision needs to be large enough to provide adequate exposure for viewing the affected structures of the hip – it’s essential in a revision procedure.

    During his presentation, Dr. Paprosky used video of various revision procedures to give attendees tips, tricks, and surgical pearls for understanding the types of acetabular bone loss and how to manage them.

    He also reviewed the pros and cons of the options for reconstructing bone defects, noting that:

    • Cages and allografts are probably not appropriate for cases of pelvic discontinuity and some type IIIB defects as they are associated with high failure rates.
    • Trabecular metal cups with augments may be a viable option for the most severe defects.
    • Preoperative radiographs are important for planning the procedure, but the surgeon should be aware that they can underestimate the degree of osteolysis seen intraoperatively.

    Click the image above to watch Dr. Paprosky’s presentation.