Bone Stock Loss and Allografting: Acetabulum

  • Wayne G. Paprosky
  • Michael S. Bradford
  • Todd D. Sekundiak


Reconstructive surgery of the failed acetabulum in revision arthroplasty is increasingly difficult to perform because of the increased bone loss as compared with that in a primary procedure. Being able to predict the bony defect preoperatively allows the surgeon to create the appropriate armamentarium for successful reconstruction. As the number of joint replacements and the time they remain in vivo increase, bony defects also increase.1–7 A historical and clinical perspective of the patient must be combined with a radiographic assessment to determine a protocol for the appropriate reconstructive procedure.


Acetabular Component Anterior Column Posterior Column Acetabular Defect Structural Allograft 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Amstutz HC, Ma SM, Jinnah RH, Mai L. Revision of aseptic loose total hip arthroplasties. Clin Orthop. 1982;170: 21–33.PubMedGoogle Scholar
  2. 2.
    Cameron HU, Bhimji S. Design rationale in early clinical trials with a hemispherical threaded acetabular component. J Arthroplasty. 1988;3:299–304.PubMedCrossRefGoogle Scholar
  3. 3.
    Lachiewicz PF, Hussamy OD. Revision of the acetabulum without cement with use of the Harris-Galante porous coated implant. J Bone Joint Surg Am. 1994;76:1834–1839.PubMedGoogle Scholar
  4. 4.
    Mallory TH, Vaughn BK, Lombardi V Jr., Reynolds HM Jr., Koenig JA. Threaded acetabular components: design rationale and preliminary clinical experience. Orthop Rev. 1988;17:305–314.PubMedGoogle Scholar
  5. 5.
    Marti RK, Schuller HM, Besselaar PP, Vanfrank Haasnoot EL. Results of revision hip arthroplasty with cement. J Bone Joint Surg Am. 1990;72:346–354.PubMedGoogle Scholar
  6. 6.
    Paprosky WG, Magnus RE. Principles of bone grafting in revision total hip arthroplasty. Clin Orthop. 1994;298:147–155.PubMedGoogle Scholar
  7. 7.
    Pellicci PM, Wilson PD Jr, Sledge CB, Salvati EA, Ranawat CS, Poss R. Revision total hip arthroplasty. Clin Orthop. 1982;170:34–41.PubMedGoogle Scholar
  8. 8.
    Pellicci PM, Wilson PD Jr, Sledge CB, Salvati EA, Ranawat CS, Poss R, et al. Long-term results of revision total hip replacement: a follow-up report. J Bone Joint Surg Am. 1985;67:513–516.PubMedGoogle Scholar
  9. 9.
    Cameron HU, Jung YB. Acetabular revision with a bipolar prosthesis. Clin Orthop. 1990;251:100–103.PubMedGoogle Scholar
  10. 10.
    Hunter GA, Welsh RP, Cameron HU, Bailey WH. The results of revision of total hip arthroplasty. J Bone Joint Surg Br. 1979;61:419–421.PubMedGoogle Scholar
  11. 11.
    Kavanaugh BF, Ilstrup DM, Fitzgerald RH Jr. Revision total hip arthroplasty. J Bone Joint Surg Am. 1985;67:517–526.Google Scholar
  12. 12.
    Kavanaugh BF, Fitzgerald RH. Multiple revisions for failed total hip arthroplasty not associated with infection. J Bone Joint Surg Am. 1987;69:1144–1149.Google Scholar
  13. 13.
    Murray WR. Acetabular salvage in revision total hip arthroplasty using a bipolar prosthesis. Clin Orthop. 1990; 251:92–99.PubMedGoogle Scholar
  14. 14.
    Oakeshott RD, Morgan DAF, Zukor DJ, Rudan JF, Brooks PJ, Gross AE. Revision total hip arthroplasty with osseous allograft reconstruction: a clinical and roentgenographic analysis. Clin Orthop. 1987;225:37–61.PubMedGoogle Scholar
  15. 15.
    Pollock FH, Whiteside LA. The fate of massive allografts in total hip acetabular revision surgery. J Arthroplasty. 1992;7:271–276.PubMedCrossRefGoogle Scholar
  16. 16.
    Paprosky WG, Perona PG, Lawrence JM. Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6 year follow-up evaluation. J Arthroplasty. 1994;9:33–14.PubMedCrossRefGoogle Scholar
  17. 17.
    D’Antonio J, Capello WN, Borden LS, Barger WL, Bierbaum BF, Boettcher WG, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop. 1989;243:126–137.PubMedGoogle Scholar
  18. 18.
    Gore DR, Murray MP, Gardner GM, Mollinger LA. Comparison of function two years after revision of failed total hip arthroplasty and primary hip arthroplasty. Clin Orthop. 1986;208:168–173.PubMedGoogle Scholar
  19. 19.
    Ranawat CS, Dorr LD, Inglis AE. Total hip arthroplasty in protrusio acetabuli of rheumatoid arthritis. J Bone Joint Surg Am. 1980;62:1059–1065.PubMedGoogle Scholar
  20. 20.
    Azuma T, Yasuda H, Okagaki K, Sakai K. Compressed allograft chips for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Br. 1994;76:740–744.PubMedGoogle Scholar
  21. Callaghan JJ. Total hip arthroplasty: clinical perspective. Clin Orthop. 1992;276:33–40.PubMedGoogle Scholar
  22. 22.
    Callaghan JJ, Salvati EA, Pellicci PM, Wilson PD Jr, Ranawat CS. Results of revision for mechanical failure after cemented total hip replacement, 1979 to 1982: a two to five year follow-up. J Bone Joint Surg Am. 1985;67:1074–1085.PubMedGoogle Scholar
  23. 23.
    Mulroy RD, Harris WH. The effect of improved cementing techniques on component loosening in total hip replacement: an 11-year radiographic study. J Bone Joint Surg Br. 1990;72:757–760.PubMedGoogle Scholar
  24. 24.
    Repten JB, Varmarken J-E, Rock ND, Jensen JS. Unsatisfactory results after repeated revision of hip arthroplasty: 61 cases followed for 5 (1–10) years. Acta Orthop Scand. 1992;63:120–127.CrossRefGoogle Scholar
  25. 25.
    Stromberg C, Herberts P, Palmertz B. Cemented revision hip arthroplasty: a multicenter 5–9 year study of 204 first revisions for loosening. Acta Orthop Scand. 1992;63:111–119.PubMedCrossRefGoogle Scholar
  26. 26.
    Stromberg C, Herberts P. A multicenter 10-year study of cemented revision total hip arthroplasty in patients younger than 55 years old: a follow-up report. J Arthroplasty. 1994;9:595–601.PubMedCrossRefGoogle Scholar
  27. 27.
    Emerson RH Jr, Head WC. Dealing with the deficient acetabulum in revision hip arthroplasty: the importance of implant migration and use of the jumbo cup. Semin Arthroplasty. 1995;6:96–102.PubMedGoogle Scholar
  28. 28.
    Chandler HP, Penenberg BL. Bone Stock Deficiency in Total Hip Replacement: Classification and Management. Thorofare, NJ: Slack; 1989.Google Scholar
  29. 29.
    Convery FR, Minter-Convery M, Devine SD, Meyers MH. Acetabular augmentation in primary and revision total hip arthroplasty with cementless prostheses. Clin Orthop. 1990;252:167–75.PubMedGoogle Scholar
  30. 30.
    Gross AE, Allan DG, Catre M, Garbuz DS, Stockley I. Bone grafts in hip replacement surgery: the pelvic side. Orthop Clin North Am. 1993;24:679–695.PubMedGoogle Scholar
  31. 31.
    Knight JL, Fujii K, Atwater R, Grothaus L. Bone-grafting for acetabular deficiency during primary and revision total hip arthroplasty: a radiographic and clinical analysis. J Arthroplasty. 1993;8:371–382.PubMedCrossRefGoogle Scholar
  32. 32.
    Paprosky WG, Bradford MS, Jablonsky WS. Acetabular reconstruction with massive acetabular allografts. Instr Course Led. 1996;45:149–159.Google Scholar
  33. 33.
    McAllister CM, Borden LS. Allograft reconstruction of the acetabulum in revision hip surgery. Semin Arthroplasty. 1993;4:80–86.PubMedGoogle Scholar
  34. 34.
    Patch DA, Lewallen DG. Reconstruction of deficient ac-etabula using bone graft and a fixed porous ingrowth cup: a 5 year roentgenographic study. Orthop Trans. 1993;17:151.Google Scholar
  35. 35.
    Silverton CD, Rosenberg AG, Sheinkop MB, Kuli LR, Galante JO. Revision total hip arthroplasty using cement-less acetabular component: technique and results. Clin Orthop. 1995;319:201–208.PubMedGoogle Scholar
  36. 36.
    Berry DJ, Muller ME. Revision arthroplasty using an anti-protrusio cage for massive acetabular bone deficiency. J Bone Joint Surg Br. 1992;74:711–715.Google Scholar
  37. 37.
    Peters CL, Curtain M, Samuelson KM. Acetabular revision with the Burch-Schneider anti-protrusio cage and cancellous allograft bone. J Arthroplasty. 1995;10: 307–312.PubMedCrossRefGoogle Scholar
  38. 38.
    Rosson J, Schatzker J. The use of reinforcement rings to reconstruct deficient acetabulae. J Bone Joint Surg Br. 1992;74: 716–720.PubMedGoogle Scholar
  39. 39.
    Paprosky WG, Bradford MS, Jablonsky WS. Acetabular reconstruction with massive acetabular grafts. Instr Course Led. 1996;45:149–159.Google Scholar
  40. 40.
    Bradford MS, Paprosky WG. Total acetabular transplant allograft reconstruction of the severely deficient acetabulum. Semin Arthroplasty. 1995;6:86–95.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Wayne G. Paprosky
  • Michael S. Bradford
  • Todd D. Sekundiak

There are no affiliations available

Personalised recommendations