Salvage of failed acetabular cages by nonbuttressed trabecular metal cups.
Acetabular revision of failed cages or rings may be facilitated by previously placed bone graft, enabling the use of highly porous cementless hemispheric cups. We retrospectively reviewed all 15 patients who had conversion of failed antiprotrusion cages (10 patients) or roof rings (five patients) to cementless cups. All patients had restoration of bone stock (three major column, eight morselized, four combined bone grafts) performed in conjunction with their index cage or ring reconstruction arthroplasty. The minimum followup was 24 months (average, 48.3 months; range, 24-72 months). Failure was defined as radiographic cup migration. In 12 of the 15 patients, there was no radiographic change in cup position at the last followup or symptoms indicative of loosening. The average Harris hip scores improved from 31 (range, 15-48) to 69 (range, 56-87) at latest followup. Cup failure occurred in three patients. In two patients, the failed cups were revised; the third patient refused additional surgery. Our experience suggests treatment of failed cages by highly porous cementless cups is a reasonable option. However, we recommend patients be followed closely to detect cup migration, which can occur until satisfactory bony ingrowth occurs.


METHODS
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Kosashvili
Yona
Y
Orthopedic Department, Division of Arthroplasty, Mount Sinai Hospital, 600 University Avenue, Suite 476A, Toronto, Ontario, M5G 1X5, Canada. yonasofi@gmail.com
Safir
Oleg
O
Backstein
David
D
Lakstein
Dror
D
Gross
Allan E
AE
D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000295:instrumentation*; D016025:Bone Transplantation / Q000009:adverse effects / Q000295:instrumentation; D020099:Coated Materials, Biocompatible; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008670:Metals; D008875:Middle Aged; D051346:Mobility Limitation; D009983:Orthopedic Equipment; D016348:Osseointegration; D016062:Porosity; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D020127:Recovery of Function; D012086:Reoperation; D012189:Retrospective Studies; D016879:Salvage Therapy; D013499:Surface Properties; D013997:Time Factors; D017211:Treatment Failure; D016138:Walking
D020099:Coated Materials, Biocompatible; D008670:Metals