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Prosthetic Component Fixation and Bone Defect Determine Acetabular Revision Surgery

  • Eduardo García-Cimbrelo
  • Eduardo García-Rey
Chapter

Abstract

Cup revision can be a highly complex operation depending on prosthetic component fixation and the bone defect. When a cementless cup is radiographically stable and the polyethylene is replaceable, accesible osteolytic lesions are debrided and grafted and a new polyethylene liner inserted. If the polyethylene is not replaceable, it will be necessary to remove a stable cup. New tools facilitate challenging cup removals. In loosened cups with acetabular defects of less than 30% (Paprosky types 1 and 2), porous hemispherical cementless cups fixed with screws give good results. Modern trabecular metal designs have improved these good results. Morsellized allografts are useful for filling cavitary defects. In acetabular defects greater than 30% (Paprosky types 3A and 3B), a trabecular metal augment and cup should provide good clinical results. Impacted bone grafting with a cemented cup technique also produce good results in these difficult patients. Difficult cases with pelvic discontinuity require acetabular reconstruction, and acetabular plates or large cup-cage acetabular reconstructions can solve these difficult situations.

Keyword

Acetabular revision surgery Cup fixation Bone defect 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Eduardo García-Cimbrelo
    • 1
  • Eduardo García-Rey
    • 1
  1. 1.Orthopaedic Surgery Department, Hospital Universitario La Paz-IdiPazMadridSpain

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