title: [Biological downsizing : Acetabular defect reconstruction in revision total hip arthroplasty].
abstract: BACKGROUND
  Periacetabular bony defects remain a great challenge in revision total hip arthroplasty. After assessment and classification of the defect and selection of a suitable implant the primary stable fixation and sufficient biological reconstitution of a sustainable bone stock are essential for long term success in acetabular revision surgery. Biological defect reconstruction aims for the down-sizing of periacetabular defects for later revision surgeries.
  
  
  METHODS
  In the field of biological augmentation several methods are currently available. Autologous transplants feature a profound osseointegrative capacity. However, limitations such as volume restrictions and secondary complications at the donor site have to be considered. Structural allografts show little weight bearing potential in the long term and high failure rates. In clinical practice, the usage of spongious chips implanted via impaction bone grafting technique in combination with antiprotrusio cages for the management of contained defects have shown promising long time results. Nevertheless, when dealing with craniolateral acetabular and dorsal column defects, the additional implantation of macroporous metal implants or augments should be considered since biological augmentation has shown little clinical success in these particular cases.
  
  
  CONCLUSIONS
  This article provides an overview of the current clinically available biological augmentation methods of peri-acetabular defects. Due to the limitations of autologous and allogeneic bone transplants in terms of size and availability, the emerging field of innovative implantable tissue engineering constructs gains interest and will also be discussed in this article.
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Koob
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Scheidt
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: T M
authors.initials: TM
authors.lastname: Randau
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Gathen
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: M D
authors.initials: MD
authors.lastname: Wimmer
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland.
authors.forename: D C
authors.initials: DC
authors.lastname: Wirtz
authors.affiliation: Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Rheinische Friedrich-Wilhelms-Universität Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. sascha.gravius@ukb.uni-bonn.de.
authors.forename: S
authors.initials: S
authors.lastname: Gravius
mesh_terms: D065526:Acetabuloplasty / Q000295:instrumentation* / Q000379:methods*; D000077:Acetabulum / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation* / Q000379:methods; D019544:Equipment Failure Analysis; D006622:Hip Prosthesis; D006801:Humans; D008670:Metals; D015995:Prevalence; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation / Q000295:instrumentation* / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: Autologous transplants; Hip prosthesis; Homografts; Revision total hip arthroplasty; Tissue engineering