Cemented acetabular components combined with trabecular metal augments provide excellent long-term survivorship for severe acetabular bone loss

Abstract

Background: Acetabular bone loss is a challenging problem for revision hip surgeons. This study aimed to explore long-term outcomes of patients who have undergone cemented acetabular revision in conjunction with trabecular metal augmentation and impaction bone grafting in cases with significant segmental bone loss. Methods: All patients who underwent cemented acetabular revision requiring impaction bone grafting and trabecular metal augments with a minimum Paprosky score of 2B and minimum follow up of 5 years were identified. Pre- and postoperative WOMAC scores were compared. An assessment of pre- and postoperative hip centre of rotation was performed and compared to native centre of rotation. Immediate postoperative centre of rotation was then compared to radiographs at latest follow up to measure for migration of acetabular components. Results: 42 patients were identified. Mean age was 53 years old with 7 males and 35 female patients. Mean follow-up was 9.5 years. Preoperative WOMAC score was 30 and there was an increase to 90 ( p < 0.01) at latest follow-up. No hips were revised for loosening or infection. There was a mean improvement in centre of rotation of 6.80 mm (CI, 4.57–9.03 mm) which was significant ( p < 0.00002). There was no change of position of centre of rotation from immediate postoperative radiographs and those at latest follow up ( p = 0.3). Conclusions: Cemented acetabular components work well in conjunction with trabecular metal augments and impacted bone grafts in reconstructing complex acetabular defects. Together they provide immediate and long-term component stability, with excellent long-term clinical and radiological outcomes.