Porous metal augments: big hopes for big holes

The majority of acetabular defects can be reconstructed with a hemispherical acetabular component alone. However, severe bone loss encountered at the time of revision acetabular surgery can result in compromised initial fixation leading to component micromotion, failure of bone ingrowth, and mechanical failure. Porous acetabular augments offer a potential solution to enhance initial component fixation while maximizing the area for biologic ingrowth. Premanufactured metal augments can be placed independent of the acetabular component. This feature provides surgeons the flexibility to place the hemispherical acetabular component in the optimal orientation at the anatomic hip center. The augment is initially secured to the hemipelvis with multiple screws before it is then secured to the hemispherical acetabular component with the use of polymethylmethacrylate bone cement. The modularity of the augments effectively allows a custom implant to be designed intraoperatively. Porous acetabular augments offer the potential advantages of a nonresorbable material that can be inserted without extensive soft tissue stripping. Additionally, these metal augments do not carry the risk of disease transmission associated with bulk structural allograft and are manufactured in a variety of shapes and sizes. The early clinical and radiographic results of porous acetabular augments are promising, yet there remains a paucity of long-term data.