Acetabular reconstruction in Paprosky type III defects

Abstract

Objectives: Severe pelvic deficiency presents a difficult problem in hip arthroplasty. Specifically, the goals are to restore the pelvic bone stock, place the acetabular component in the correct anatomical position, and optimize joint stability. Currently, many surgical techniques have been developed for prosthetic revision surgery for acetabular complex defects, but no consensus has been reached on the best treatment. The objective of this study was to review mid-term cases of severe bone defect (Paprosky type III) treated with a bone allograft and ring Bursch-Schneider anti-protrusion cage (BSAC). Methods: A retrospective consecutive series review of the first 23 complex acetabular reconstructions performed between 2006 and 2011 was conducted. The series included the learning curve of the procedure and a minimum 5-year follow-up. Conclusion: Our study confirmed the efficacy of using a frozen morselized allograft combined with a metal ring-type BSAC for acetabular reconstruction. The anatomical location of the center of rotation of the hip must be recovered for long-term success. In massive loosening cases, the anatomical center of rotation can only be restored by bone density reconstruction using a graft protected by a ring to improve the centering of the head.