Dealing with the deficient acetabulum in revision hip arthroplasty

Variable bone loss is the defining feature of the failed acetabulum. Preoperative planning must include an assessment of the extent of bone deficiency. When bone loss precludes a routine revision there are three reconstructive options, a small cup in the false acetabulum, reconstruction of the lost bone with an allograft, and a jumbo cup filling the expanded acetabulum. The investigators have found that the latter technique can often be used in the setting of the difficult acetabulum with improvement in hip mechanics and avoiding a structural bone graft. When a graft is necessary, the best technique is a small graft and large fixed cup, with support of both the cup and graft on as much host bone as possible. A posterior buttressing plate should be considered for any graft providing substantial posterior support of the acetabular component.