Reconstruction of acetabular deficiency

Management of the acetabular deficiency in revision total hip arthroplasty (THA) or dysplastic hips (DDH) is a technical demanding procedure. Preoperatively, the acetabular deficiency must be assessed and classified into contained or uncontained defects. A contained defect may be reconstructed with morselized allografts and a noncemented acetabular component. Uncontained loss of bone stock involving ≤50% of the acetabulum can be reconstructed with structural or morselized allografts and noncemented acetabular component. In case of uncontained defect involving >50% of the acetabulum, with or without associated pelvic discontinuity, structural allografts in conjunction with a reconstruction cage may be required. In some occasions, the acetabular deficiency is so severe, and the host acetabular bed is poorly vascularized; autogenous iliac bone grafts may be required in the host-allograft junction to facilitate healing of the allografts. The general principles of this type of reconstruction include to restore the center of rotation of the hip joint, achieve stable fixation of the component, and restore the bone deficiency and adequate healing of the grafts to the host bone.