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INTRODUCTION: Several surgical options can be offered to manage iliopsoas impingement. Research published on cup replacements often concerns a small population size or multicentre studies, suggesting a variety of indications. We conducted a retrospective single centre study screening according to a specific protocol of a population of patients who had a cup replacement for iliopsoas impingement. The objectives were: 1) to specify the functional outcomes and the achievement of the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) according to the Oxford-12 score, and 2) to assess the complication rate. HYPOTHESIS: Our hypothesis was that acetabular replacements achieve a Minimal Clinically Important Difference (MCID) in more than 80% of cases. PATIENTS AND METHODS: Fifty-five hips underwent acetabular revision between 2011 and 2020. Forty-three were performed as first-line surgery, eight after failed tenotomy and four after failed anterior hip capsule thickening plasty. A CT scan of all the hips revealed a median overhang of 9 mm (7; 12) and a 7 ° cup anteversion (2; 19). Follow-up included assessment of the Oxford-12 score using MCID and PASS, the Merle d'Aubigné score, an assessment of hip flexion muscle strength using the Medical Research Council scale, and an assessment of satisfaction and complications. RESULTS: At a mean follow-up of 3 years (2-10), the difference in the Oxford score before and at follow-up was 18 points (15; 27) (p < 0.001), the median Medical Research Council score was 4.5 (4; 5) and patients were satisfied or very satisfied in 73% of cases (40/55). The MCID was achieved for 87% of the hips (48/55), and the PASS was achieved in 67% of cases (33/55). The rate of complications involving surgical revision was 10.9% (6/55) with respectively: two anterior dislocations, one early infection on day 10 resolved after wound irrigation and appropriate antibiotic therapy, one intraoperative fracture of the trochanter requiring osteosynthesis and one arthroscopic revision to remove a free cement fragment. CONCLUSION: Due to a good functional outcome but a high complication rate, a cup replacement can be offered for iliopsoas impingement associated with acetabular malposition or significant overhang. LEVEL OF EVIDENCE: IV.

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INTRODUCTION: In revision total hip arthroplasty (THA), the advent of porous custom-made triflange acetabular implants with 3D scan planning offers a new perspective to improve implantation accuracy and anatomical restoration of the center of rotation (COR). This issue was investigated using CT-scan as the measurement tool, but in limited series (±10 cases) and without investigating the factors that may influence errors in positioning. Therefore we performed a retrospective study aiming to: (1) assess the placement accuracy of such implants with respect to the preoperative planning, (2) examine whether the volume of bone to be resected in order to apply the implant had an impact on this accuracy, (3) assess if errors in position at surgery had any influence on function, complications and survival. HYPOTHESIS: Preoperative planning could be accurately reproduced when implanting porous custom-made acetabular implants, and that accuracy would decrease in proportion to the volume of bone to be resected METHOD: Twenty patients undergoing THA revision with porous custom-made acetabular implants were included in this single-center retrospective study. Mean follow-up was 17.9 months ± 9.4 [2-45.1]. Preoperative planning was performed using 3D scanographic modeling. A post-operative CT scan was performed to assess implantation accuracy in terms of orientation and COR restitution. Demographic data, Oxford scores, complications and survival were recorded. RESULTS: Mean deviation from the preoperative planning in inclination, anteversion and rotation were 4.3 ° ± 2.5, 6.1 ° ± 4.7, and 7 ° ± 4.6, respectively. Restoration of the COR showed a mean deviation of 2.1 ± 1.3 mm anteroposteriorly, 2.5 ± 2 mm mediolaterally and 2.2 ± 1.3 mm proximodistally. In total, 45% (9/20) of implants were positioned with perfect restoration of orientation (±10 °) and COR (±5 mm). The mean planned bone resection was 8.1 ± 4.9 cm3, with placement accuracy and COR restitution decreasing significantly when the volume of bone to be resected exceeded 2.7 cm3. One dislocation was found (5%, 1/20). Survival at last follow-up was 100%, the mean Oxford score at follow-up was 31.7 ± 7.9 [16-52], without being influenced by errors in position or COR restitution. CONCLUSION: In total 45% of the implants restored an orientation and a COR as planned, particularly when the volume of bone to be resected is less than 2.7 cm3. Although these are complex cases with large amounts of bone loss, 3D manufacturing could give us hope of greater precision. The link between better precision and low bone resection volume could be an area to develop with the manufacturer in order to improve results. LEVEL OF EVIDENCE: III; diagnostic using CT in transversal retrospective study.

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BACKGROUND: Research on hip instability has focused on establishing "safe" ranges of combined component position in supine posture or functional placement of the acetabular component based on the hip-spine relationship. A new angle, the polar axis angle (PAA), of the total hip arthroplasty (THA) components describes the concentricity of both components and can be evaluated in functional positions that confer a greater risk of instability (ie, sitting). The goal of this study was to compare the PAA in functional positions between patients who experienced a postoperative dislocation and a matched control group who did not have a dislocation. METHODS: An institutional database was searched for patients experiencing a dislocation after primary THA. Patients who had postoperative full-length standing and lateral-seatedradiographs were included in the dislocator group. A control group of nondislocator patients was matched 2:1 by age, body mass index, sex, and hip-spine classification. Radiographic measurements of the neck angle, acetabular ante-inclination, and PAA were performed by 2 separate blinded, trained reviewers. RESULTS: The lateral-seated neck angle and lateral-seated PAA measurements were significantly lower in the dislocator groups (n = 37) than the control group (n = 74) (23 versus 33 degrees, P < .001; 74 versus 83 degrees, P = .012, respectively). Significant differences were also observed in changes in the polar axes and neck angles between standing and seated positions (P < .001 and P < .001, respectively). When comparing patients who have mobile spines versus stiff spines within the dislocator group, there were no differences in the acetabular, neck, or PAAs. The effect of neck angle on the PAA showed a linear trend across cohorts. CONCLUSIONS: Patients who experience postoperative instability have a significantly lower PAA on lateral-seated radiographs when matched for age, sex, body mass index, and hip-spine classification. In addition, the lower seated PAA is driven more strongly by decreased functional femoral anteversion, which emphasizes the role of functional femoral version on stability in THA.

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Acetabular revision arthroplasty, a demanding field of reconstructive hip surgery, calls for innovative strategies to deal with challenging bone defects and implant failure seen in revision cases. Conventional implant solutions might fall short of adequately addressing severe bone loss and ensuring stable fixation, highlighting the necessity of customized strategies. Personalized megaimplants, distinguished by their tailor-made design and large-scale construction, present a viable option to overcome these challenges. The present article provides an elaborate analysis of custom-made megaimplants in acetabular revision arthroplasty, shedding light on the underlying principles, design complexities, manufacturing methods, applications in the clinical setting, and outcome assessment. The aim of this review is to present a comprehensive insight into personalized megaimplants and their contribution to the advancement of orthopedic surgery.

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BACKGROUND: Isolated acetabular component revision is an effective treatment for revision total hip arthroplasty patients who have well-fixed femoral implants. We aimed to evaluate the modes of acetabular failure following primary total hip arthroplasty and to identify factors associated with increased morbidities and postoperative outcomes. METHODS: We conducted a retrospective analysis and identified 318 isolated aseptic acetabular revisions. We separated patients by ≤90 days, 91 days to 2 years, and >2 years for acetabular revisions and compared demographics, reasons for revision, 90-day readmissions, rerevisions, and postrevision infections. Revisions ≤90 days, 91 days to 2 years, and >2 years accounted for 10.7, 19.2, and 70.1% of revisions, respectively. Revisions ≤90 days, 91 days to 2 years, and >2 years had their primary total hip arthroplasty at a mean age of 66, 63, and 55 years (P < .001), respectively. RESULTS: Revisions within 90 days were mainly indicated for dislocation/instability (58.8%) or periprosthetic fracture (23.5%) while revisions over 2 years were indicated for polyethylene wear/osteolysis (37.2%). Patients with revisions past 90 days were more likely to require rerevision compared to patients with revisions within 90 days (P < .001). There were no differences in readmissions (P = .28) or infection rates (P = .37). CONCLUSIONS: Acetabular revisions within 90 days were more commonly indicated for instability and periprosthetic fracture, while those over 2 years were indicated for polyethylene wear. Revisions past 90 days were more likely to require subsequent rerevisions without increased 90-day readmissions or infections. LEVEL III EVIDENCE: Retrospective cohort study.

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BACKGROUND: Porous tantalum components and augments have demonstrated short to midterm fixation stability in acetabular total hip arthroplasty (THA) revision but do not offer a novel option to decrease the postoperative dislocation rate. Recently, dual mobility (DM) cups have gained interest to decrease the prevalence of recurrent hip instability after revision hip arthroplasty, but this issue was not confirmed combined with use of tantalum reconstruction devices. Therefore, we did a retrospective study aiming to: (1) evaluate at a 5-year minimum follow-up period the dislocation rate (and other intra- and postoperative complications), (2) assess radiographic results specifically looking at osseointegration and restoration of the hip center, (3) and also clinical results in a cohort of patients who underwent complex acetabular reconstruction with trabecular metal revision components associated with a cemented DM socket. HYPOTHESIS: Using a DM socket cemented in porous tantalum components can reach the low risk of hip dislocation reported with DM components in revision setting without increasing the risk of a mechanical failure. METHODS: A cross-sectional study identified 174 THA revision including an acetabular revision. Were excluded 118 revisions with acetabular defects Type 1, 2a or 2B according to Paprosky's classification, as well as 18 hips revised without a dual mobility and 3 patients (3 hips) lost to follow-up. Were thus included in this study 35 hips (35 patients) implanted with uncemented total hip arthroplasty revision using both trabecular metal acetabular cup-cage reconstruction and a cemented DM cup. Seven hips were classified Paprosky types 2C, 15 type 3A and 13 types 3B. Patients were followed with clinical and radiological evaluation regarding dislocation rate, infection, reoperation or re-revision, osseointegration and restoration of the hip center, and functional results according to the Harris hip score and psoas impingement presence. RESULTS: At a mean follow-up of 8.1±1.8 years (5.1-12.6), one dislocation was recorded, and one acute deep infection. No patient required a cup re-revision for septic or aseptic loosening. The survivorship at 8years regarding revision for any cause as an endpoint was 96.5% (CI95%: 92-99). Osseointegration of TM implants was analyzed and found no acetabular migration at the last follow-up in the cohort. The mean hip center position was optimized from 48±7mm (37-58) to 34±5mm (29-39) vertically and from 26±5mm (-18-36) to 24±8mm (7-31) horizontally without reaching significance (p=0.1). On the last follow-up X-rays, the mean acetabular inclination was 47̊±9̊ (32̊-61̊). According to the criteria of Hirakawa, 97.1% (34/35) of the hip centers were restored. One cup (2.9%) was more than 5mm proximally from the hip center, and none more than 10mm. Clinical results assessed a Harris Hip Score improved from 36±17 (23-62) preoperatively to 82±15 (69-93) at last follow-up (p<0.0001). Two patients (2/35, 5.7%) complained of psoas impingement. CONCLUSION: This study suggests effectiveness of DM cups in association with a tantalum-made acetabular shell for reconstruction of large bone defect in THRs for both solving postoperative instability and aseptic loosening without increasing the re-revision rate for any reason in a midterm follow-up. LEVEL OF EVIDENCE: IV; observational study.

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BACKGROUND: Custom-made implants are a valid option in revision total hip arthroplasty to address massive acetabular bone loss. The aim of this study was to assess the accuracy of custom-made acetabular implants between preoperative planning and postoperative positioning using CT scans. METHODS: In a retrospective analysis, three patients who underwent an acetabular custom-made prosthesis were identified. The custom-made designs were planned through 3D CT analysis considering surgical points of attention. The accuracy of intended implants positioning was assessed by comparing pre- and postoperative CT analyzing the center of rotation (CoR), anteversion, inclination, screws, and implant surface in contact with the bone. RESULTS: The three cases presented satisfactory accuracy in positioning. A malpositioning in the third case was observed due to the posterization of the CoR of the implant of more than 10 mm. The other CoR vectors considered in the third patient and all vectors in the other two cases fall within 10 mm. All the cases were positioned with a difference of less than 10° of anteversion and inclination with respect to the planning. CONCLUSIONS: The current case series revealed promising accuracy in the positioning of custom-made acetabular prosthesis comparing the planned implant in preoperative CT with postoperative CT.

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BACKGROUND: Acetabular bone loss is a challenging clinical problem when performing revision total hip arthroplasty (rTHA). This study aimed to evaluate how acetabular bone loss severity influences (1) clinical outcomes and (2) patient-reported outcome measures (PROMs) in rTHA patients. METHODS: Patients who underwent rTHA with acetabular component revision from January 2016 to February 2022 were included. Treating surgeons determined Paprosky acetabular bone loss classification intraoperatively. Patients were grouped based on numeric classification (PI, PII, or PIII) to categorize severity. Hip disability and Osteoarthritis Outcome Score for Joint Replacement (HOOS, JR.) and Lower Extremity Activity Scale (LEAS) score were collected preoperatively and 1 year postoperatively. There were 197 patients included. Paprosky classification was PI for 47 patients (23.9%), PII for 113 patients (57.4%), and PIII for 37 patients (18.8%). Mean clinical follow-up was 29 months (range, 1 to 69). RESULTS: Reoperation rate was 0% (0 patients), 6.2% (7 patients), and 10.8% (4 patients) for PI, PII and PIII groups respectively (P = .052). Mean preoperative HOOS, JR. and LEAS for PI, PII and PIII groups were significantly different, but 1-year postoperative HOOS, JR. and LEAS did not differ significantly. Rates of HOOS, JR. minimal clinically important difference achievement differed significantly between bone loss groups. CONCLUSION: In this study of rTHA patients, greater acetabular bone loss severity was associated with worse preoperative PROMs and trended toward higher reoperation rate. Postoperative PROMs for bone loss severity groups were statistically similar. Patients who had worse acetabular bone loss were more likely to achieve HOOS, JR. minimal clinically important difference postoperatively. LEVEL OF EVIDENCE: III.

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BACKGROUND: The advent of highly porous ingrowth surfaces and highly crosslinked polyethylene has been expected to improve implant survivorship in revision total hip arthroplasty. Therefore, we sought to evaluate the survival of several contemporary acetabular designs following revision total hip arthroplasty. METHODS: Acetabular revisions performed from 2000 to 2019 were identified from our institutional total joint registry. We studied 3,348 revision hips, implanted with 1 of 7 cementless acetabular designs. These were paired with highly crosslinked polyethylene or dual-mobility liners. A historical series of 258 Harris-Galante-1 components, paired with conventional polyethylene, was used as reference. Survivorship analyses were performed. For the 2,976 hips with minimum 2-year follow-up, the median follow-up was 8 years (range, 2 to 35 years). RESULTS: Contemporary components with adequate follow-up had survivorship free of acetabular rerevision of ≥95% at 10-year follow-up. Relative to Harris-Galante-1 components, 10-year survivorship free of all-cause acetabular cup rerevision was significantly higher in Zimmer Trabecular Metarevision (hazard ratio (HR) 0.3, 95% confidence interval (CI) 0.2-0.45), Zimmer Trabecular MetaModular (HR 0.34, 95% CI 0.13-0.89), Zimmer Trilogy (HR 0.4, 95% CI 0.24-0.69), DePuy Pinnacle Porocoat (HR 0.24, 95% CI 0.11-0.51), and Stryker Tritanium revision (HR 0.46, 95% CI 0.24-0.91) shells. Among contemporary components, there were only 23 rerevisions for acetabular aseptic loosening and no rerevisions for polyethylene wear. CONCLUSION: Contemporary acetabular ingrowth and bearing surfaces were associated with no rerevisions for wear and aseptic loosening was uncommon, particularly with highly porous designs. Therefore, it appears that contemporary revision acetabular components have dramatically improved upon historical results at available follow-up.

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The use of tricalcium phosphate (TCP) as a bone substitute is gaining increasing interest to treat severe acetabular bone defects in revision total hip arthroplasty (rTHA). The aim of this study was to investigate the evidence regarding the efficacy of this material. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was assessed using the modified Coleman Methodology Score (mCMS) for all studies. A total of eight clinical studies (230 patients) were identified: six on TCP used as biphasic ceramics composed of TCP and hydroxyapatite (HA), and two as pure-phase ceramics consisting of TCP. The literature analysis showed eight retrospective case series, of which only two were comparative studies. The mCMS showed an overall poor methodology (mean score 39.5). While the number of studies and their methodology are still limited, the available evidence suggests safety and overall promising results. A total of 11 cases that underwent rTHA with a pure-phase ceramic presented satisfactory clinical and radiological outcomes at initial short-term follow-up. Further studies at long-term follow-up, involving a larger number of patients, are needed before drawing more definitive conclusions on the potential of TCP for the treatment of patients who undergo rTHA.

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BACKGROUND: Revision total hip arthroplasty (THA) presents a greater risk to patients than primary THA, and surgical approach may impact outcomes. This study aimed to summarize acetabular revisions at our institution and to compare outcomes between direct anterior and posterior revision THA. METHODS: A series of 379 acetabular revision THAs performed from January 2010 through August 2022 was retrospectively reviewed. Preoperative, perioperative, and postoperative factors were summarized for all revisions and compared between direct anterior and posterior revision THA. RESULTS: The average time to acetabular revision THA was 10 years (range, 0.04 to 44.1), with mechanical failure (36.7%) and metallosis (25.6%) being the most prevalent reasons for revision. No differences in age, body mass index, or sex were noted between groups. Anterior revision patients had a significantly shorter length of stay (2.2 versus 3.2 days, P = .003) and rate of discharge to a skilled nursing facility (7.5 versus 25.2%, P = .008). In the 90-day postoperative period, 9.2% of patients returned to the emergency department (n = 35) and twelve patients (3.2%) experienced a dislocation. There were 13.2% (n = 50) of patients having a rerevision during the follow-up period with a significant difference between anterior and posterior approaches (3.8 versus 14.7%, respectively, P = .049). CONCLUSION: This study provides some evidence that the anterior approach may be protective against skilled nursing facility discharge and rerevision and contributes to decreased lengths of stay. We recommend surgeons select the surgical approach for revision THA based on clinical preferences and patient factors.

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INTRODUCTION: Isolated head and liner exchange in aseptic revision total hip arthroplasty (rTHA) is an appealing option rather than full acetabular component revision; however, early outcome reports suggest high rates of complications requiring re-revision. This study seeks to compare the outcomes of these procedures. METHODS: This retrospective study assessed 124 head and liner exchanges and 59 full acetabular cup revisions conducted at a single center between 2011 and 2019 with at least 2 years of follow-up. Baseline demographics did not vary by group. Mean follow-up was 3.7 (range 2.0-8.6) years. RESULTS: In the head and liner exchange group, re-revision-free survivorship at 2 years was 79% for all-causes and 84% for aseptic reasons. In the full acetabular revision group, it was 80% for all causes (p > 0.99) and 83% for aseptic reasons (p > 0.99). The 2-year survivorship of head and liner exchange was non-inferior to that of full acetabular revision, correcting for surgical indication and history of prior revision (adj-OR 0.1.39, 95% CI, 0.62-3.28, p = 0.99). A best-fit multivariable model found that revision for instability (adj-OR=3.03, 95% CI 1.40-6.66, p = 0.005), prior revision (adj-OR 2.15; 95% CI, 0.87-5.32; p = 0.10), current smoking (adj-OR 2.07; 95% CI, 0.94-4.57; p = 0.07), and obesity (adj-OR 0.58; 95% CI, 0.24-1.36; p = 0.22) were associated with failure within 2 years. CONCLUSIONS: In this analysis, 2-year outcomes for isolated head and liner exchange were non-inferior to full acetabular component revision. A future randomised prospective study should be conducted to better assess the optimal approach to revision in an aseptic failed hip arthroplasty.

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BACKGROUND: The annual rate of primary THA has been increasing with new designs promoting THA in the younger population, therefore increasing rates and complexity of hip revision surgeries. Different types of acetabular defects in hip revisions, usually make the use of primary cementless cups quite difficult. In complex defects, using cages with cemented cups or combining cementless cups with metal augments, are possible reconstruction solutions. The Delta TT acetabular revision system provides a solution to complex defects combining the advantages of both cage construct and primary implants, with modularity that helps restore anatomical hip centre and biomechanics. The aim of this study is to evaluate the short-term results of the use of the Delta TT revision system in acetabular revision surgeries. TYPE OF THE STUDY: A retrospective case series. METHODS: 24 patients underwent acetabular revision using (Delta TT) revision system, from 2018 to 2021. The mean follow-up was 20.75 months. Clinical and functional outcomes were assessed using Harris Hip Score. RESULTS: The use of the Delta TT revision system in acetabular revision surgery provided adequate pain relief, and early patient mobilization. The preoperative HHS mean of 29.88 improved to a mean of 85.21, at the last, follow-up. None of the patients developed periprosthetic infection or loosening or nerve palsy during the follow-up period. CONCLUSION: Short-term clinical outcomes for the use of the Delta TT revision cup system in acetabular revision are encouraging with good functional outcomes and patient satisfaction.

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BACKGROUND: While common, studies assessing outcomes of failed metal-on-metal (MoM) resurfacings converted to total hip arthroplasties (THAs) are limited. We determined the outcomes following revision THA of aseptic MoM hip resurfacings. METHODS: Between 2000 and 2019, we identified 52 revision THAs for failed MoM hip resurfacings through our total joint registry. Mean age was 55 years, 42% were women, and mean body mass index was 28 kg/m2. Adverse local tissue response led to THA in 67% of the cases. The most common revision articulation was metal-on-cross-linked or ceramic-on-cross-linked polyethylene (71%). Median head size was 36 mm. The acetabular component was retained in 21% and 28% used dual-mobility constructs. The mean follow-up was 6 years (range, 2-12 years). RESULTS: The 5-year survivorships free of any re-revision or reoperation were 89% and 85%, respectively. The primary cause of re-revision (6) was dislocation (4). The 5-year cumulative probability of dislocation was 19% and was 13% in those patients treated with dual-mobility constructs versus 22% in those treated with standard articulations (P = .58). No dislocations occurred in THAs with retained acetabular components and dual-mobility constructs versus a 5-year cumulative probability of dislocation of 25% in those with revised acetabular components and standard articulations (P = .24). CONCLUSION: Revision THAs for aseptically failed MoM hip resurfacings yielded a 5-year survivorship free of re-revision of 89%. The main reason for failure was dislocation, which was reduced, but not statistically significantly, when a dual-mobility construct was used, especially if the acetabular component was retained. LEVEL OF EVIDENCE: IV.

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Background: This study was aimed at evaluating the changes in cup coverage (CC) and hip center of rotation (HCOR) in acetabular defects of various severities treated with acetabular revision using jumbo cups. Methods: A total of 86 hips were included. The American Academy of Orthopedic Surgeons (AAOS) classification of these patients was as follows: 16 patients, AAOS I; 16 patients, AAOS II; and 16 patients, AAOS III. A three-dimensional (3D) implant simulation technique was used to visualize the placement of jumbo cups during revision arthroplasty. The acetabular anteversion, inclination, CC, and the HCOR were measured. Results: The inclination and anteversion of simulated acetabular cups in AAOS I-III groups were consistent with the normal acetabular anatomy. Compared with the controls, in AAOS I-III groups, the HCOR was significantly increased and CC was significantly decreased. The HCOR elevation was significantly higher in AAOS III patients than in AAOS I (p = 0.001) and AAOS II patients (p < 0.001). The use of the jumbo cup technology for acetabular revision would decrease the CC in AAOS I-III patients to 86.47, 84.78, and 74.51%, respectively. Conclusion: Our study demonstrated that in patients with acetabular defects, acetabular revision arthroplasty using jumbo cups will lead to decreased CC and HCOR upshift. Upon classifying these patients according to the AAOS classification, CC decreased with the severity of acetabular defects, and the elevation of the HCOR in AAOS III patients exceeded 10 mm and was significantly higher than in other patients.

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OBJECTIVES:  To evaluate the role of isolated acetabular revision with modular trabecular titanium implants using simple extraction and reinsertion of femoral monoblock cemented stem (tap-out tap-in technique). BACKROUND: In the past years, we face the burden of revising hip arthroplasties in predominantly elderly population. METHODS: Single institution retrospective analysis of 17 hips in 16 patients with previous cemented total hip arthroplasty implanted between 1988 and 2007. These patients underwent isolated acetabular revision between 2010 and 2018 using modular acetabular Delta Trabecular Titanium (TT) system (Limacorporate S.p.a, Udine, Italy) with impaction bone grafting and reverse reamed allografts. Non-modular polished cemented stems (Poldi-Cech monoblock) were reinserted without additional cementing. RESULTS: Out of the total cohort (17 hips), 14 hips showed no signs of loosening or graft resorption as well as no femoral loosening during the median follow­up period of 5.1 (2 to 8.5 years). In one patient, fracture of cranial acetabular module occurred 4 months after the revision, one patient sustained two hip dislocations, and one patient developed deep infection resulting in permanent implant removal. CONCLUSION: Isolated acetabular revision using modular trabecular titanium implant with reinsertion of the original non-modular monoblock cemented femoral stem is a safe and effective technique in adequately selected patients (Tab. 3, Fig. 4, Ref. 30).

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BACKGROUND: The objective of this study was to compare cup survival and the incidence of adverse events associated with the use of trabecular metal (TM) and non-TM cups for acetabular revision surgery. METHODS: The MEDLINE, EMBASE, and Cochrane Library databases were searched for comparative studies that reported cup survival and the incidence of adverse events associated with the use of TM and non-TM cups for acetabular revision surgery. Primary outcomes included cup survival, aseptic loosening, dislocation, and infection. RESULTS: The meta-analysis included 6 studies that involved 13,864 total hip arthroplasty (THA) revisions who underwent acetabular revision surgery with TM (n = 5,619) or non-TM (n = 8,245) cups. The meta-analysis demonstrated no significant difference in cup survival using re-revision for any reason or aseptic loosening as the endpoint following acetabular revision surgery with TM or non-TM cups (HR = 0.96; [95% CI, 0.84-1.09]; HR = 1.29; [95% CI, 0.70-2.38]). Pooled data indicated that the overall incidence of adverse events for TM or non-TM cups was 6.8% (382/5,289) and 9.0% (725/8,083), respectively, and not significantly different (OR = 0.91; [95% CI, 0.80-1.04]). The incidence of aseptic loosening and infection were significantly lower (OR = 0.75; [95% CI, 0.58-0.96]; OR = 0.70; [95% CI, 0.54-0.90]) and the incidence of dislocation was significantly higher (OR = 1.53; [95% CI, 1.22-1.91]) for TM compared to non-TM cups. CONCLUSION: This review was the first to use reconstructed time-to-event data to find that there was no difference in survival of TM and non-TM cups in acetabular revision surgery. Overall, fewer adverse events were associated with the use of TM compared to non-TM cups, but the difference was not significant. The incidence of aseptic loosening and infection were significantly lower and the incidence of dislocation was significantly higher for TM compared to non-TM cups. This information is expected to guide orthopedic surgeons in the selection of appropriate acetabular components for THA revision.

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Introducción: El recambio acetabular primario puede llegar a ser una intervención de gran complejidad en dependencia del defecto óseo existente. Las lesiones pueden ser segmentarias, cavitarias o combinadas. Este último patrón es el que se observa con mayor frecuencia en pérdidas óseas periprotésicas por aflojamiento aséptico. Objetivos: Mostrar la evolución de la cirugía de recambio en la artroplastia de cadera, y orientar al cirujano en la toma de decisiones de modo individualizado, para evitar las complicaciones. Método: Se realizó la investigación basada en el tema de estudio, mediante la revisión de libros de texto de la especialidad, artículos científicos publicados en diferentes bases de datos informáticas: Pubmed/MEDLINE, SciELO, BVS, Scopus, Ebsco, Google Scholar, Cochrane, así como otras consultas en bibliotecas médicas. Análisis de la información: Las prioridades en la planificación de la reconstrucción se establecen para proporcionar un implante estable, restaurar la masa ósea y optimizar la biomecánica de la cadera, aunque son los hallazgos intraoperatorios los que definitivamente indicarán el tipo de intervención a seguir. Las exigencias funcionales de los pacientes y las comorbilidades deben ser consideradas, así como el coste-efectividad de la reconstrucción planificada. Conclusiones: La artroplastia total de cadera ha demostrado mejorar significativamente la calidad de vida en pacientes, con una baja tasa de complicaciones. Para prevenir el aflojamiento aséptico es necesario ser cuidadosos en la técnica de colocación de los componentes protésicos y utilizar el tipo de material más adecuado a la edad, demanda funcional y reserva ósea de cada paciente(AU)

Introduction: Primary acetabular replacement can become a highly complex intervention depending on the existing bone defect. Lesions can be segmental, cavitary, or combined. This last pattern is the one most frequently observed in periprosthetic bone loss due to aseptic loosening. Objectives: To show the evolution of replacement surgery in hip arthroplasty, and to guide the surgeon in making individualized decisions, to avoid complications. Method: A research was carried out on the study topic, by reviewing specialty textbooks, scientific articles published in different databases such as Pubmed/ MEDLINE, SciELO, BVS, Scopus, Ebsco, Google Scholar, Cochrane, as well as other inquiries in medical libraries. Information analysis: Reconstruction planning priorities are established to provide a stable implant, restore bone mass, and optimize hip biomechanics, although it is the intraoperative findings that will definitely indicate the type of intervention to follow. The functional demands of the patients and the comorbidities must be considered, as well as the cost-effectiveness of the planned reconstruction. Conclusions: Total hip arthroplasty has been shown to significantly improve the quality of life in patients, with low rate of complications. To prevent aseptic loosening, it is necessary to be careful in the technique of placement of the prosthetic components and to use the type of material most appropriate to the age, functional demand and bone reserve of each patient(AU)

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BACKGROUND: The custom triflange acetabular component is used during revision THA to address severe acetabular bone loss. Midterm results are promising, with low rates of loosening and triflange revision reported. However, reoperation and overall complication rates remain high. We aim to investigate our institution's custom triflange experience over 20 years by evaluating implant survivorship, reoperations, complications, and clinical outcomes. METHODS: Prospectively collected data were reviewed for 50 patients undergoing revision THA with the use of a triflanged component from January 2000 to December 2018. 94% among these cases had a known outcome or minimum two year follow-up. Outcomes related to the triflange component were recorded, including revisions, reoperations, surgical complications, medical complications, Harris hip scores, and patient satisfaction. Phone interviews were conducted with patients whose recent follow-up exceeded 2 years. Radiographic review was performed to define implants as either stable or unstable. RESULTS: The average Harris hip scores improved 24 points (49 to 73; P < .001). 91% of eligible patients were satisfied at follow-up. One patient was scheduled for revision at an outside institution during the study period. There were 2 reoperations (1 acute infection and 1 screw removal). One patient died due to pulmonary thromboembolism. A Trendelenberg gait was present in 46% (23/50) of patients. There were 14 major complications (28%). Dislocation (12%) was the most common complication. CONCLUSION: Custom triflange components provide a reliable solution for managing complex acetabular defects in revision THA. Patients should be counseled on magnitude of surgery and the high incidence of complications, specifically infection and dislocation.

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PURPOSE: The use of porous tantalum augments and titanium-coated cups in primary total hip arthroplasty (THA) with acetabular defects has shown satisfactory outcomes in our centre. The aim of this study was to report the long-term radiological and clinical outcomes of using this combination for Paprosky type III acetabular bone defects in acetabular revision. PATIENTS AND METHODS: Between January 2007 and January 2015, 45 patients with Paprosky type III acetabular defects underwent acetabular revision using a combination of porous tantalum augments and titanium-coated cups. Among these, 41 patients (41 hips) had complete follow-up. Thirty-one patients had a Paprosky type IIIA defect, and ten patients had a Paprosky type IIIB defect. No patients had pelvic discontinuity. There were 20 males and 21 females with an average age of 63.2 years (range 35-80) at the time of revision surgery. RESULTS: The mean follow-up was 122.8 months (range 69-165). The Harris Hip Score (HHS) improved significantly from 32.1 points (range 17-58) pre-operatively to 85.3 points (63-98) at the last follow-up. The Short Form-12 (SF-12) and Hip Dysfunction and Osteoarthritis Outcome Score (HOOS) improved significantly for each item at the last follow-up. Two patients had a high hip centre post-operatively. One patient had recurrent dislocation but did not require re-revision. No further revision of the acetabular components was required, and all hips remained stable at the last follow-up with bony ingrowth of the acetabular components according to the criteria of Moore et al. CONCLUSION: The combination of tantalum augments and conventional titanium-coated cups achieved satisfactory long-term radiographic and clinical outcomes for Paprosky type III acetabular bone defects without pelvic discontinuity.

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