Table 4.
Surgical management of acetabular cup revision: cases (C) categorized accordingly with Paprosky classification. Bone loss: intraoperative assessment according to the Paprosky system. Gruen: radiographical assessment of periacetabular osteolysis according with Gruen zones, * retroacetabular stress-shielding. Cup stability and integrity: bearing surface damaged and MoM coupling unless otherwise stated, intact: mirror-polished bearing surface. Cup replacement: HC hemispherical cup, the difference in cup diameter (in millimeters) before and after revision; the number of screws is provided between brackets, screws are fixed in posterior quadrants unless otherwise stated, AI screw in the anterior-inferior quadrant. Bone substitutes: Mg-HA Magnesium doped hydroxyapatite, Coll-(Mg-HA) collagen-Mg-HA composite scaffold; struct structured, autolog autologous, homolog homologous. Notes: COR center of rotation. OL off-label.
| Bone loss | C | Gruen | Cup stability and integrity | Cup replacement (screws) | Bone substitutes | Notes |
|---|---|---|---|---|---|---|
| 1 | 5 | none | stable intact | / | / | OL: Primary cup + DMA |
| 6 | * | stable intact | / | / | OL: Primary cup + DMA | |
| 7 | * | stable | HC +6 (2) | / | Remarkable cup lateralisation before revision. | |
| 8 | * | stable intact | / | / | OL: Primary cup + DMA | |
| 11 | none | stable | HC+2 (3) | / | / | |
| 14 | none | stable intact | / | / | OL: Primary cup + DMA | |
| 2a | 1 | 1,3 | stable | HC +4(2) | / | Remarkable cup migration directed superiorly with intact superior acetabular rim |
| 2 | 1,3 | loosened MoP | HC -2 (5) | Coll-(Mg-HA) | Revision with undersized cup and COR elevation | |
| 2c | 4 | 1*,2,3 | stable | HC +0(3 + 1 AI) | Mg-HA granules, Coll-(Mg-HA) | / |
| 9 | 2,3 | loosened | HC +4 (3) | / | Coxa profunda | |
| 10 | 2,3 | stable | HC +2 (2) | Mg-HA granules, Coll-(Mg-HA) | / | |
| 12 | 1,2 | loosened MoP | HC -10 (2) | Mg-HA granules, Coll-(Mg-HA) | Undersized cup with elevated COR was implanted (Fig. 4) | |
| 3a | 3 | 1,2,3 | loosened MoP | HC +0 (5) | struct autolog bone graft, Mg-HA granules | / |
| 13 | 1,2,3 | loosened | HC +4 (3) | struct autolog bone graft, Mg-HA granules, Coll-(Mg-HA) | Early failure of the structured graft. | |
| 15 | 1,2,3 | stable | HC +6, 3 iliac winglets and caudal hook (4) | struct and morcelized homolog bone graft | Hip dysplasia; intraoperative fracture of posterior column |