Fig. 3.

a) Anteroposterior (AP) radiograph of pelvis and upper femur region showing loose spanning porous cage of a 65-year-old female who had undergone five prior revision total hip arthroplasty procedures resulting from prior trauma. The cage has failed via an abduction pullout mechanism from the inferior pelvis. An extended polyethylene (+ 5 mm) constrained bearing is locked into the cage. CT scan showed segmental bone loss of posterior column, medial quadrilateral plate, and anterior rim. b) Postoperative AP radiograph showing pelvic reconstruction with a custom triflange porous cage; 28 ml of Cerament was injected behind the cage into all defects before inserting a Freedom constrained bearing into the ring-loc mechanism. A long medullary screw was inserted into the superior ramus to counteract abduction pullout stresses. c) AP pelvic radiograph 66 months postoperatively. Pelvic reconstruction remains stable. The bone graft substitute site shows retroacetabular remodelling, but no trabecular bone patterns are observed.