Cementing Multihole, Metal, Modular Acetabular Shells Into Cages in Revision Total Hip Arthroplasty

Acetabular components of total hip arthroplasties can loosen and migrate, sometimes resulting in severe osseous pelvic deficiencies that make reconstruction with standard acetabular components impossible. Reconstructive techniques used in this setting commonly involve placing a cage or ring for reconstruction. All-polyethylene acetabular components traditionally are cemented into these constructs. Disadvantages of this technique include possible recurrent dislocations, disassociation of polyethylene component from cement, and polyethylene wear. Traditional reconstructive techniques require major revision of the construct to address such problems. In this article, we describe a technique in which a multihole, metal acetabular shell is cemented into a cage or ring, permitting use of modular liners. This technique results in secure fixation to the cage and gives the surgeon the option of changing liners in cases of wear or instability. We report outcomes in 13 cases with follow-up ranging from 3 months to 133 months. Cementing a modular metal shell into a cage can be a viable alternative to cementing a polyethylene liner. This technique has resulted in durable fixation of shell to cage in our experience and permits use of variable liner options.