Reverse augmentation technique in hip revision arthroplasty: a new strategy for the management of acetabular reconstruct
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(2020) 15:396
TECHNICAL NOTE
Open Access
Reverse augmentation technique in hip revision arthroplasty: a new strategy for the management of acetabular reconstruction Christian Götze* and Christian-Dominik Peterlein
Abstract Background: The principle of acetabular total hip revision (THR) is based on acetabular reconstruction and restoration of the center of rotation. The use of augmentation in high cranial acetabular defects combined with a cementless revision shell was studied sufficiently. This study aimed to report a case with the use of an augment inside a cementless revision shell as a reverse augmentation technique. Methods: We describe the case of an 86-year-old female patient with a massive acetabular defect during second revision for total hip arthroplasty (THA). Two problems occurred: (1) a fixed cemented stem with a nonmodular head size of 33 mm and (2) a high acetabular defect with an elevated rotation center. Results: With the distraction technique, allograft filling was used to reconstruct the acetabular defect. A cementless revision shell (REDAPT, Smith and Nephew) with a size of 78 mm was used to stabilize the defect. Locking screws placed cranially and distally were used to stabilize the cup for secondary osseointegration. An augment was placed inside the cup to reconstruct the rotation center. A customized polyethylene liner (outer diameter, 54 mm/inner diameter, 33 mm) was positioned below the augment in the revision cup to reconstruct the center of rotation. An 18-month postoperative X-ray analysis showed a stable construct with full secondary osseointegration. Conclusion: This is the first report of an augment used for a reverse technique inside a cementless shell to restore the center of rotation with the use of a customized polyethylene liner. This might be a reliable option for reconstruction of the center of rotation in large cementless revision cups in acetabular Paprosky type III defects. This technical note shows the possibility of using an augment as a reverse technique in a cementless revision cup. Keywords: Acetabular defect, Augmentation technique, Restoration of the center of rotation
Background Acetabular revision arthroplasty is based on three main principles. The first is the primary stable fixation of the revision cup in the acetabular defect after second principle, which is bony reconstruction. The third principle is the restoration of the center of rotation to avoid instability and to maintain long-term stability. Different implant designs and sizes are available for THA acetabular revisions [1]. In the last decade, * Correspondence: [email protected] Clinic for Orthopedics, Auguste-Viktoria Clinic, Ruhr University Bochum, Am Kokturkanal 2, 32545 Bad Oeynhausen, Germany
a trend towards cementless revision systems has occurred [2]. With regard to the extent of acetabular defects, bony allograft reconstruction or metal augmentation seems to be the choice for addressing major bone loss [3]. Different studies present sufficient results of acetabular meta
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