Cup-Cage Constructs for Acetabular Revisions With Pelvic Discontinuity

Abstract

Pelvic discontinuity associated with bone loss is a complex challenge in acetabular revision surgery. Reconstruction with an anti-protrusion cage and highly porous cementless cup construct, more briefly known as the cup-cage technique, is a relatively new approach to addressing this challenge. A review was done of 32 consecutive acetabular revision reconstructions in 30 patients with pelvic discontinuity and bone loss treated with the cup-cage technique. The average follow-up of these patients was 44 months (range, 24 to 75 months). Failure was defined as more than 5 mm migration of the acetabular cup component of the revision construct. In 29 of the 32 revisions (90.6%), there was no clinical or radiographic evidence of loosening of the acetabular cup component. The patients’ Harris hip scores improved significantly (P <0.001), from 46.6 ± 10.4 at baseline to 78.7 ± 10.4 (mean ± SD) at the time of the last follow-up visit. In three revisions (9.4%), the cup-cage construct had migrated at 1 year after surgery. Complications included 2 dislocations of the femoral head, 1 infection, and 1 partial palsy of the peroneal nerve. Treatment of pelvic discontinuity with a cup-cage construct is a reliable option for restoring pelvic mechanical stability in the short-term after revision total hip arthroplasty.

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