The three revolutions in acetabular revision surgery for total hip replacement: 1. Definite and 2. Probable

Acetabular revision surgery has been and remains a difficult challenge in total hip replacement surgery. Cemented acetabular revisions have not worked out as well as would be desirable. With the introduction of the hemispherical cementless acetabular component, either pressfit or fixed with screws, a major change has been accomplished in the problem of fixation. This is the first revolution in acetabular revision surgery. The second and third revolutions are potential and important. The second revolution that may take place is the reduction in periprosthetic osteolysis, secondary to the use of highly crosslinked, melted, polyethylene. The third potential revolution is the reduction in the incidence of dislocation that could result from the use of heads of larger diameter. The in vitro studies suggest that certain highly crosslinked polyethylenes can be used with a larger head diameter without the risk of a major increase in particulate debris. Potentially this could address many of the issues of the high incidence of dislocation following acetabular revisions. In addition, the combination of a large head and a highly crosslinked polyethylene has allowed a new form of constrained acetabular component to be designed. This many be another advance in terms of the problems of recurrent dislocation.