Acetabular revision surgery revisited: do changing indications influence bone defect management? A comprehensive...

Modern bearings have changed reasons for revision hip surgery; however, acetabular bone defects are still a challenging condition. Advanced imaging techniques, including newer 3D preoperative planning, have improved the understanding of bone stock. Current acetabular tools reduce the bone loss during implant removal and are reliable to predict the new reconstruction. Although bone allograft is useful in younger patients with a high lifetime risk for revision, some limitations have been reported for segmental large defects and pelvic discontinuity. Encouraging results are obtained with porous metal augments and custom-made implants in combination or not with bone grafts, but long-term results and cost-effectiveness are controversial. In this review, we aimed to address the best rationale to this complex topic 25 years after the introduction of highly cross-linked polyethylene. Furthermore, we sought to identify whether the lower prevalence of osteolysis eases acetabular revision surgery within the increasing number of re-revision surgeries.