Augments in acetabular revisions surgery

Reconstruction of the failed acetabular component in total hip arthroplasty can be challenging; multiple reconstructive options are available, being a cementless acetabular component the reconstructive method of choice for the majority of revisions whether at least 50% of the implant contacts host bone. When the degree and location of bone loss is mostly supero-lateral, with an oval-shaped cavity, oblong cups or porous-coated bilobed cups can also be used; such implants are in fact designed to fill these defects and achieve a stable cementless anchorage with no significant bone loss. In revisions for defects of type IIB and IIIA-IIIB according to Paprosky, the alternative is an acetabular reconstruction with hemispherical cup combined with a trabecular metal augments. Its material properties and unique nanostructure allows for increased structural stability and promotes biological fixation. The augment fills the defect, obviating the need for a structural allograft, and increases the surface area for host-bone contact facilitating the bone ingrowth. This method also allows anatomic positioning of the hemispherical cup restoring the hip biomechanics and it is associated with good clinical an radiographic results. We report our experience on the use of this method of reconstruction.