CORR Insights(®): THA revisions using impaction allografting with mesh is durable for medial but not lateral acetabular defects.

Abstract

S evere bone deficiency is a major challenge in acetabular revision surgery. At one time, reconstructing the acetabulum with cement and a reinforcing device to the native bone was a popular treatment option. This procedure, however, was ultimately abandoned due to poor results at medium or long-term followup [1, 12, 13]. The use of threaded, oversized-threaded, oblong, or ‘‘jumbo’’ cups likewise failed to yield good results at long-termfollowup [7, 9, 10].While some studies [6, 8, 11] maintain that massive bulk allograft remain an option, slow resorption and substitution by native bone (creeping substitution) takes placeonlyon the surface of the allograft, and perhaps because of this, in the long-term, the failure rate of this approach can be high. By contrast, one technique that seems to have stood the test of time is impaction bone grafting (IBG). This approach appears to stimulate bone regeneration, neovascularization, and predictable creeping substitution; support for this approach includes experimental studies in animals, imaging studies (conventional radiographic followup, PETTAC), biopsies in retrievals, and clinical and radiographic followup reports out to 25 years. [2–5].