title: Acetabular defect reconstruction in revision hip arthroplasty with a modular revision system and biological defect augmentation.
abstract: OBJECTIVE
  Revision of failed total hip arthroplasty with severe acetabular bone loss represents a rare but challenging problem. Anatomic reconstruction with biological defect augmentation as solid bone transplants or cancellous bone restores bone stock while providing good component stability. The objective of this study was to present short- to mid-term results of revision total hip arthroplasty with a modular ring system in a consecutive series of patients with severe acetabular bone loss.
  
  
  METHODS
  We retrospectively reviewed 39 consecutive patients (39 hips) with severe acetabular bone loss (Paprosky type 3 A and 3 B) reconstructed with revision total hip arthroplasty using the cementless modular ring system MRS-Titan®. The MRS-Titan® consists of independent ring systems that are adapted modularly to the defect situation. Combined with acetabular defect reconstruction by using cancellous bone in impaction grafting technique, the MRS-Titan® system offers a cement-free revision system that enables defect-adapted customization to individual anatomic matters, bridging of the acetabular bone defect and reconstruction of the centre of rotation. Initial stability of the implant was obtained by screw fixation. Harris hip score and sequential radiographs were used to evaluate clinical and radiographic results.
  
  
  RESULTS
  At an average follow up of 31 months (range 12-69 months) 33 of 39 (84.6 %) of the implants were considered radiographically stable without signs of acetabular migration of more than 2 mm in the horizontal or vertical direction, implant rotation or screw breakage. Complications included six implant failures (15 %). We recorded one aseptic loosening of the MRS prosthesis after 20 months. Five patients (12.8 %) had to undergo revision surgery because of periprosthetic joint infection. Two patients had a dislocation postoperatively. The mean Harris hip score improved from 27 ± 14 points preoperatively to 76 ± 15 points at the time of last follow up.
  
  
  CONCLUSIONS
  By achieving stable implant fixation and providing potential for biological fixation, treatment of severe acetabular bone loss in revision total hip arthroplasty with the modular ring system MRS-Titan provides a durable solution with good clinical and radiographic results and allows us to accomplish major goals of reconstruction.
authors.affiliation: Department for Orthopedics and Trauma Surgery, University of Bonn, Bonn, Germany, Jan.Schmolders@ukb.uni-bonn.de.
authors.forename: Jan
authors.initials: J
authors.lastname: Schmolders
authors.forename: Max J
authors.initials: MJ
authors.lastname: Friedrich
authors.forename: Robert D
authors.initials: RD
authors.lastname: Michel
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Randau
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Wimmer
authors.forename: Andreas C
authors.initials: AC
authors.lastname: Strauss
authors.forename: Hendrik
authors.initials: H
authors.lastname: Kohlhof
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Wirtz
authors.forename: Sascha
authors.initials: S
authors.lastname: Gravius
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use*; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011474:Prosthesis Design; D012086:Reoperation / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements