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The use of a massive allograft along with an antiprotrusio cage for the treatment of large periprosthetic acetabular defects can restore structural integrity to the pelvis and provide durable revision-free survival.
The treatment of severe pelvic deficiency in the setting of revision total hip arthroplasty can be a perplexing problem to a hip reconstruction surgeon. Optimizing hip stability; achieving durable, stable fixation of the components; and restoring patient function are the goals of the procedure. Many treatment options, such as acceptance of a high hip center, use of a jumbo cup with or without augments, cage or cup-cage constructs, custom triflanged cups, and use of a bulk allograft with a prosthesis, have been described. To date, no comparative clinical trials have been reported as far as we know. It is unlikely that this will ever be done, given the rarity of this condition and the uniqueness of each individual case. While there are advantages and disadvantages of each procedure, the success of using an allograft and cage construct is highly dependent on the surgical technique. In the present report, we describe this technique and highlight important considerations that help to optimize the outcome.
