[Multiple surgical possibilities for the correction of acetabulum failure in rheumatoid arthritis]

Pronounced osteoporosis of and surrounding the acetabulum commonly leads to early loosening of endoprosthetic hip replacements following implantation. Large osseous defects in the subimplant bed are the result and the reason why multiple revisions of loosened acetabular cups have to be performed so often in rheumatic surgery. The defects extend from the cranial to the central; ventral and dorsal anchorage losses may occur in addition to this. The anchorage of a new implant must be adapted to the individual circumstances. The new implant must be selected in accordance with point of surgical access, the patient's general status and osseous regenerationability. In the optimum case, osseous buildup of lost anatomical structures is the preferred method. If this is not possible, special implants, mostly custom-made prostheses, have to be incorporated. However, the survival time of the implants is much shorter than in patients with degenerative diseases.