Surgical tactics in revision operations of the hip acetabulum

Surgical tactics in acetabulum revisions is based on 2 elements. The first of these is the assessment of the patient's general health (age, clinical status, and concomitant diseases). Adequate planning makes it possible to avoid further complications, such as problems with bone transplant incorporation and subsequent mobility of the acetabulum. The second element is the assessment of bone stock deficits, especially in the acetabular ring. Although it is possible to determine the extent of bone deficits intraoperatively, in preoperative planning we use conventional X-rays, CT scans, and - in cases of advanced protrusion - angiography. The subsequent surgical technique is planned on the basis of the bone deficits as classified by Paprosky.
In the reconstruction of deficit we use different methods and implant cement or cementless acetabula, depending on the patient's age and the bone quality. In certain cases supporting metal rings, mesh, or other implants are used. To fill the deficit we implant frozen, radiated allogenic bone transplants, morselized or as solid blocks.
The revision operation is planned to reconstruct the joint axis on the same level as on the opposite side to restore the off-set. 338 patients with acetabular loosening were operated in the years 1997-2000.
The material indicates the need for the so-called biological attitude to the problem.