Cementless Acetabular Components Research Articles

Hip resurfacing: a 40-year perspective.

Saving bone by resurfacing the femoral head is not a new concept and the appeal for this type of hip replacement has remained despite the difficulties to find a bearing material suitable for this procedure. In this article, the unique experience of a surgeon who has been performing hip resurfacing since its early development is presented, along with a comparative analysis of the performance of successive designs. The overall 10-year Kaplan-Meier survivorship of the early designs with polyethylene bearings did not exceed 62% while that of the current Conserve®Plus metal-on-metal hybrid design implanted with second generation surgical technique is in excess of 92%. Further exceptional, in the 10-year survivorship, 99.7% has been achieved with femoral size of 46mm and good bone quality. Cementless acetabular components provide better enduring fixation than cemented designs. Metal-on-metal is currently and fortunately the only highly successful bearing material that can combine low wear rates and the manufacturing of a thin acetabular component to preserve bone and still accommodate the large femoral head of a hip resurfacing. The adverse local tissue reactions (ALTR) associated with metal-on-metal devices are not a bearing material issue per se but one of the device design and surgical technique. Almost all of ALTR and the rare events of systemic toxicity are due to abnormal wear patterns which can be prevented by proper acetabular component design and precise socket orientation in both the coronal and sagittal planes. Further improvements of the long-term durability with hip resurfacing can be anticipated with the use of recently developed trabecular bone-like tantalum or titanium porous coatings and with proper training of the surgeons interested in performing hip resurfacing arthroplasty.

The Acetabular Component in Primary Total Hip Arthroplasty

The cemented all-polyethylene acetabular component has almost completely been replaced by the cementless porous-coated acetabular component. A variety of different designs, incorporating several types of porous coatings, have proven to be reliable and durable. The ability to reposition a cementless cup to optimize component orientation allows the joint replacement surgeon to minimize impingement and maximize component stability. This is essential to prevent dislocation and damage to bearing surface of the acetabular component. Insertion of a hemispherical cementless cup with 1 mm of under-reaming typically allows for secure interference fit, good apposition of the implant to the underlying bone, an insignificant risk of pelvic fracture, and a rare risk of ingrowth failure.

Progression of Periacetabular Osteolytic Lesions

The development of three-dimensional computed tomography (CT) imaging techniques has enabled the detection, accurate measurement, and monitoring of periprosthetic osteolytic lesions. The aim of this study was to track the progression in size of osteolytic lesions and to determine those factors that are associated with the risk of progression. A secondary aim was to investigate whether progression in size of osteolytic lesions could be monitored with use of radiographs. We retrospectively determined, with use of sequential CT scans, the progression of periacetabular osteolysis over a period of as much as nine years in a cohort of twenty-six patients (thirty acetabular components) in whom the cementless acetabular component or components had been in place for longer than ten years at the time of the initial CT scan. High-resolution CT scans with metal-artifact suppression were used to determine the volume of osteolytic lesions. Progression in the size of osteolytic lesions per year was calculated as the change in the volume of osteolytic lesions between serial CT scans. Associations were determined between the progression in size of osteolytic lesions, osteolysis rate at the initial CT, patient age, sex, walking limitations, and activity level. Progression in size of osteolytic lesions as determined with use of CT was compared with that determined with use of radiographs. Mean progression in the size of osteolytic lesions, as determined with use of CT, was 1.5 cm(3)/yr (range, 0 to 7.5 cm(3)/yr). The amount of osteolysis at the initial CT scan and patient activity were good predictors of osteolytic lesion progression. The strongest predictor of osteolytic lesion progression occurred when these two risk factors were combined (p = 0.0019). The value of radiographs was limited to monitoring of larger lesions identified by CT. This is the first study to report on the progression of osteolysis adjacent to cementless acetabular components from medium to long-term follow-up. The data suggest that the osteolysis rate at the initial CT and patient activity can be useful factors in predicting the progression in size of periacetabular osteolytic lesions.

Cementless acetabular reconstruction after acetabular fracture

Total hip arthroplasty (THA) is a common surgical treatment when significant joint changes and pain are present after acetabular fracture. Few series have been reported in the literature with cemented and uncemented acetabular components. The aim of this study was to analyze the long-term results of cementless acetabular components inserted in acetabula that had been altered with previous fracture and to compare these results to those of routine THA. Twenty-four uncemented total hip arthroplasties were performed for the treatment of posttraumatic arthritis after acetabular fracture. The mean age and follow-up was 56 years and 8.4 years, respectively. The results were compared with 48 primary uncemented total hip arthroplasties in patients with nontraumatic arthritis. Clinical assessment with Harris hip score and radiologic with special interest in the socket was made. No significant difference between the two cohorts was found with regard to postoperative follow-up, perioperative transfusion requirements, reoperations, and acetabular survival. Between both cohorts, there were significant differences with regard to operative time and postoperative Harris score. Cementless THA is a suitable treatment for posttraumatic arthritis after acetabular fracture. Therapeutic study, level III.

Cementless two-staged total hip arthroplasty for chronic periprosthetic infection

To determine the clinical outcomes of two-staged cementless revision arthroplasty for the treatment of deep periprosthetic infection after total hip arthroplasty. Twenty-three patients with deep periprosthetic infection treated with a standard protocol of two-staged cementless revision hip arthroplasty were enrolled in this study. There were 9 male patients and 14 female patients with an average age of 64 years (range, 52-78 years). In all cases, antibiotics-loaded cement spacers were implanted after removal of all the prosthetic components and thorough debridements had been done. All patients had a minimum of 2 weeks of intravenous antibiotics followed by 4 weeks of oral antibiotics after implant removal. After a mean interval of 6.7 months (3-28 months), revision arthroplasties were carried out with cementless femoral components followed by 2 weeks of intravenous antibiotics and 4 weeks of oral antibiotics. The mean follow-up period was (4.3±3.5) years. There were 2 cases of recurrent infections in this study. Intraoperative periprosthetic fractures were observed in 3 patients. One patient had dislocation of the implanted spacer during the interval period and 2 patients had hip dislocation after reimplantation. Mild subsidence of femoral component occurred in 1 patient. There were no cases of loosening of femoral components and cementless acetabular components in patients without infection recurrence. The Harris hip score increased from a preoperative mean of 36±13 to 85±13 at 12 months after reimplantation. Using cementless prostheses in two-staged revisions of hip periprosthetic infections can provide low rate of infection recurrence and good implant stability, but cautions must be taken when treating patients with infection caused by multidrug-resistant organisms.

“But Doc, I Just Had This Fixed!” Unexpectedly High Revision Rates of Cementless Acetabular Components in Younger Patients at Long-Term Follow-up

“But Doc, I Just Had This Fixed!” Unexpectedly High Revision Rates of Cementless Acetabular Components in Younger Patients at Long-Term Follow-up

Primary Cementless Acetabular Fixation at a Minimum of Twenty Years of Follow-up

The purpose of the present study was to analyze the longer-term results for a previously reported cohort of patients with cementless acetabular fixation and to compare the results with those for historical controls with cement fixation and a comparable follow-up period. One hundred and twenty consecutive nonselected total hip arthroplasties were performed in 108 patients with use of a cementless acetabular component. This series was evaluated at a minimum of twenty years of follow-up and was compared with 330 consecutive hip arthroplasties that had been performed by the same surgeon with use of cemented acetabular components and had been followed for a comparable period of time. Thirty-nine patients (forty-two hips) in the cementless fixation group were living at twenty years of follow-up. In the group of 120 hips with cementless acetabular fixation, twenty-two hips (18.3%) were revised during the follow-up period, but only one hip (0.8%) was revised because of loosening of the acetabular component, with no additional cup loosening since the previous report at thirteen to fifteen years of follow-up. In the group with cemented acetabular fixation with comparable follow-up, thirty-two hips (10%) were revised overall and eighteen hips (6%) were revised because of acetabular loosening. An additional twenty-five hips (8%) had acetabular cups that were loose on radiographs but had not undergone revision. At a minimum of twenty years of follow-up, cementless acetabular components provided superior long-term fixation compared with cemented components but the overall rates of acetabular revision for mechanical reasons were comparable.

The 15° face-changing acetabular component for treatment of osteoarthritis secondary to developmental dysplasia of the hip

We report the use of a 15° face-changing cementless acetabular component in patients undergoing total hip replacement for osteoarthritis secondary to developmental dysplasia of the hip. The rationale behind its design and the surgical technique used for its implantation are described. It is distinctly different from a standard cementless hemispherical component as it is designed to position the bearing surface at the optimal angle of inclination, that is, < 45°, while maximising the cover of the component by hostbone.

Cementless Acetabular Fixation in Patients 50 Years and Younger at 10 to 18 Years of Follow-Up

The purpose of the study was to evaluate the 10- to 18-year follow-up of cementless acetabular fixation in patients 50 years and younger. We retrospectively reviewed a consecutive group of 118 patients (144 hips) in whom primary total hip arthroplasty had been performed by 2 surgeons using a cementless acetabular component. Two (1.4%) cementless acetabular components were revised because of aseptic loosening. Twenty-four hips (16.7%) were revised for any mechanical failure of the acetabular component mostly related to acetabular liner wear and osteolysis. The average linear wear rate was 0.19 mm per year, which was higher than our previous reports with cemented acetabular fixation. The fiber mesh ingrowth surface of the cementless acetabular component in this study was superior to cemented acetabular components in terms of fixation. However, the high rates of wear and osteolysis have led to poor overall acetabular component construct survivorship.

Use of cementless acetabular component with a hook and iliac flanges in revision arthroplasty for massive acetabular defect

BackgroundRevision hip arthroplasty of massive acetabular defect, severe combined defect, or pelvic discontinuity is challenging. The purpose of this study was to determine the midterm outcome and survivorship of a new revision technique using cementless acetabular cup supplemented with a hook and three iliac flanges in massive acetabular defects. MaterialsFrom January 2000 to June 2004, we revised 17 severe acetabular defects, 14 combined defects and three pelvic discontinuities according to the American Academy of Orthopaedic Surgeons (AAOS) classifications, in which bone stock at the dome was not available to provide support for the cup. These revisions were performed using a cementless porous-coated hemispherical cup with a hook and flanges. ResultsOne patient (one hip) underwent resection arthroplasty due to infection 1year after the revision. The remaining 16 hips were evaluated at a mean of 6.8 (range 5–9) years postoperatively. Thirteen acetabular components (81%) showed no migration and were stable with bone ingrowth. Three hips showed progressive medial and upward migration during the 18–24 months after the index revision, after which migration was not progressive. The Merle d’Aubigné hip score was 14.5 (range 12–18) points at the latest follow-up evaluation. Survival rate was 94.4% when revision for any reason was considered as the end point [95% confidence interval (CI) 83.9–100%] and 82.0% (95% CI 62.8–100%) when loosening of the cup was considered as the end point. ConclusionResults of this type of revision were superior to previously reported results of acetabular revisions with the use of various techniques and devices.

Surgical Approaches to OA Therapy: Osteotomy and Arthroplasty

Total hip and knee replacement are among the most successful surgical procedures in medicine. The long-term survival of total hip replacements for which both the femoral and acetabular components were fixed to the surrounding bones with cement demonstrates durable results [1, 3], even in young patients [11]. For example, 35-year follow-up of cemented total hip replacements revealed a survival rate of 78% with the need for revision surgery for any reason as the end point [3]. In younger patients, the 25-year survival is 93% for the femoral component, though only 77% for the cemented acetabular component [11]. The introduction of newer designs that relies on biologic fixation through bone ingrowth into porous coatings on the metallic components has also proven durable. Twenty-year survival of porous-coated acetabular components has been reported at 86% [6] with revision for any reason associated with the acetabular component as the end point. In a direct comparison of cemented and cementless acetabular components performed by the same surgeon [8], survival at 18 years improved from 81% to 94%. Long-term results for porous-coated femoral components are just as impressive [2, 7, 9]. Joint replacement patients enjoy function which is comparable to their peers without osteoarthritis. Patient-reported outcomes such as the short-form health outcomes survey (the SF-36), together with objective functional measures, such as the 6-min walk, show no meaningful differences between total hip patients and normative values (Fig. 1). Fig. 1 SF-36 scores for total hip replacement patients (“Study”), those patients with two or more comorbidities, and normative values (“Norm”) demonstrate that total hip patients reach levels found in the normal age-matched population ... The major problem remaining in total hip replacement is the bearing surface. Osteolysis caused by the biological reaction to wear debris remains a common mode of failure. Considerable improvement has been made in the wear resistance of bearing surfaces, most recently by the widespread adoption of highly cross-linked polyethylene for acetabular components. Randomized clinical trials comparing cross-linked to conventional polyethylene show reductions in wear and osteolysis [13], though follow-up is not long enough at this time to determine the impact of these improvements on the need for revision surgery. Like total hip replacement, total knee replacement has similar durable results up to 10 to 20 years [4, 8–20]. Unicondylar knee replacement, in which only one compartment is replaced, has similar outstanding results, at least in older patients, though younger patients have not fared as well at long-term follow-up [17]. As with hip replacement, wear and osteolysis are major issues, particularly with modular designs for which backside wear between the polyethylene insert and the metallic tray provides an added source of debris [14]. This appears to apply especially in young, active osteoarthritis patients [16]. Similarly, mobile-bearing designs which incorporate a second bearing surface between the tibial insert and the tibial tray have an excellent long-term survival, but osteolysis secondary to an increased burden of wear debris appears to increase with time [4]. Cementless fixation has not gained acceptance in total knee replacement as it has in total hip replacement, despite promising long-term results [10]. Osteotomies are another surgical treatment for osteoarthritis, aimed at realigning joint surfaces and thus delaying disease progression. Newer procedures for osteotomies around the hip are encouraging at mid-term follow-up, with acceptable complications when performed by well-trained surgeons [5]. Knee procedures include closing and opening wedge osteotomies performed in the proximal tibia. Closing wedge osteotomies have produced unpredictable results that are not always durable [15]. Newer opening wedge osteotomies may provide more durable and more predictable results, but no long-term follow-up is available.

Sex differences in the morphological failure patterns following hip resurfacing arthroplasty

BackgroundMetal-on-metal hybrid hip resurfacing arthroplasty (with a cementless acetabular component and a cemented femoral component) is offered as an alternative to traditional total hip arthroplasty for the young and active adult with advanced osteoarthritis. Although it has been suggested that women are less appropriate candidates for metal-on-metal arthroplasty, the mechanisms of prosthesis failure has not been fully explained. While specific failure patterns, particularly osteonecrosis and delayed type hypersensitivity reactions have been suggested to be specifically linked to the sex of the patient, we wished to examine the potential influence of sex, clinical diagnosis, age of the patient and the size of the femoral component on morphological failure patterns in a large cohort of retrieved specimens following aseptic failure of hip resurfacing arthroplasty.MethodsFemoral remnants retrieved from 173 hips with known patient's sex were morphologically analyzed for the cause of failure. The results were compared with the control group of the remaining 31 failures from patients of unknown sex. The odds ratios (OR) and 95% confidence intervals (CI) of the following morphologically defined variables were calculated using logistic regression analysis: periprosthetic fractures (n = 133), osteonecrosis (n = 151), the presence of excessive intraosseous lymphocyte infiltration (n = 11), and interface hyperosteoidosis (n = 30). Logistic regression analysis was performed both unadjusted and after adjustment for sex, age, the size of the femoral component, and preoperative clinical diagnosis.ResultsFemoral remnants from female patients had a smaller OR for fracture (adjusted OR: 0.29, 95% CI 0.11, 0.80, P for difference = 0.02) and for the presence of osteonecrosis (adjusted OR: 0.16, 95% CI 0.04, 0.63, P for difference = 0.01). However, women had a higher OR for both the presence of excessive intraosseous lymphocyte infiltration (adjusted OR: 10.22, 95% CI 0.79, 132.57, P for difference = 0.08) and interface hyperosteoidosis (adjusted OR: 4.19, 95% CI 1.14, 15.38, P for difference = 0.03).ConclusionsWithin the limitations of this study, we demonstrated substantial sex differences in distinct failure patterns of metal-on-metal hip resurfacing. Recognition of pathogenically distinct failure modes will enable further stratification of risk factors for certain failure mechanisms and thus affect future therapeutic options for selected patient groups.

Contemporary Total Hip Arthroplasty with and without Cement in Patients with Osteonecrosis of the Femoral Head

We previously evaluated ninety-eight consecutive patients (148 hips) at mean of 9.3 years after total hip arthroplasty; the mean age at the time of the index surgical procedure was 47.3 years. Fifty patients (100 hips) had simultaneous bilateral arthroplasty with a cemented stem in one hip and a cementless stem in the contralateral hip. Forty-eight patients (forty-eight hips) had unilateral hip arthroplasty with a cementless stem. All patients had a cementless acetabular component. In our first report, we found no difference in clinical results, as measured with the Harris hip score and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), between the cementless and cemented stems. One hip (2%) in the hybrid group (a cementless cup and a cemented stem) had revision because of infection and two hips (2%) in the fully cementless group had revision of the femoral component because of a periprosthetic fracture. Between the time of follow-up in that study (at a mean of 9.3 years) and the time of follow-up in the present study (at a mean of 17.3 years), twenty-two revisions of acetabular components were performed, with eight in the hybrid group and fourteen in the fully cementless group. There was no difference in clinical results, as measured with the Harris hip score and the WOMAC, between the hybrid and fully cementless groups. At the time of the present review, forty (83%) of forty-eight acetabular components in the hybrid group and eighty (85%) of ninety-four acetabular components in the fully cementless group were intact. Most of the femoral components (98%) in both groups were intact. Wear and periacetabular osteolysis were the causes of failure in the hips requiring revision.

Total Hip Arthroplasty in Patients with High Dislocation

We report the updated results at a minimum of fifteen years after eighty-four consecutive total hip arthroplasties performed in sixty-seven female patients with high dislocation of the hip. Sixty-four arthroplasties were performed in forty-nine patients, between 1976 and 1994, with Charnley low-friction acetabular and femoral components inserted with cement; nineteen arthroplasties were performed in seventeen patients, between 1990 and 1994, with the hybrid technique (acetabular component inserted without cement and femoral component inserted with cement); and one arthroplasty was done in 1991, with cementless acetabular and femoral components. All patients were followed prospectively on the basis of clinical assessment according to the Merle D'Aubigné and Postel scoring system, as modified by Charnley, and with radiographic analysis. At the time of the latest follow-up, twenty-six hips (41%) in the low-friction arthroplasty series, ten hips (53%) in the hybrid series, and the one hip with the cementless components had been revised for various reasons. The primary reason for revision in the low-friction arthroplasty group was aseptic loosening of the components (twenty-four hips), whereas the predominant reason for the revisions in the hybrid series and in the hip with cementless components was progressive polyethylene liner wear (six hips). After the minimal follow-up of fifteen years, twenty-five low-friction hip replacements and eight hybrid-type hip replacements had remained intact for an average of twenty-one years (range, seventeen to thirty-two years) and sixteen years (range, fifteen to nineteen years), respectively. These findings may be used in comparisons of results with newer techniques and designs.

Total Hip Replacement in the Dysplastic Hip: The Use of Cementless Acetabular Components

Objectives: The aim of this study was to examine the early results of patients with acetabular dysplasia treated with the use of uncemented acetabular components and without complex bony augmentation. Materials and Methods: Eleven patients (13 hips) were included in this study. The median acetabular component size was 44mm (range, 4456mm). The mean follow up period was 24 months (range, 15-59 months). All patients were pain free at follow up. Results: The mean Merle d'Aubigne Postel score increased from 3 to 17. Our early results suggest that acetabular reconstruction using a small cementless cup, may be an alternative to previously described methods of total hip arthroplasty in the presence of superolateral bone loss.

Hybrid Cemented/Cementless Total Hip Replacement in Dogs: Seventy‐Eight Consecutive Joint Replacements

To evaluate the use of hybrid total hip replacement (THR), using a cementless acetabular component and a cemented femoral component. Prospective case series. Client-owned dogs (n = 71). Consecutive clinical cases that had hybrid THR were studied. Radiographic features, pain scores, and lameness scores were recorded pre- and postoperatively. Longer term outcome was assessed by owner questionnaire. Hybrid THRs (n = 78) were performed in 71 dogs. Four cases (5%) had major postoperative complications; 3 were resolved after revision surgery, and 1 owner requested an explantation. No other major complications were identified on follow-up radiographs (67 THR) at 12 weeks. On clinical follow up (77 THR) at 4 weeks, lameness had improved in 68, was unchanged in 8, and was worse in 1. Pain had decreased in 72, was unchanged in 4, and was worse in 1. At 12 weeks (69 THR) compared with preoperative status, lameness had improved in 67 and was unchanged in 2. Pain had improved in 68 and was unchanged in 1. Longer term follow-up (mean, 16 months) was available for all hips. No further complications were reported. Owner satisfaction was good for 76 THRs and reasonable for 2. Hybrid THR can be performed successfully with a low complication rate and represents an alternative to either entirely cemented or cementless implantation.

Distribución de la osteólisis periprotésica en la cadera. Estudio con resonancia magnética

Introduction Magnetic resonance imaging (MRI) is useful in assessing bone and soft tissue lesions due to the production of wear particles. Our objective was to study the distribution of lesions in patients with one type of cementless acetabular component with this technique. Material and methods We included 40 total hip arthroplasty with press-fitted hydroxyapatite porous-coated cup and multiple optional screw holes performed over a mean of 13 years. We studied the presence, extent and continuity of the granulomatous lesion and osteolysis with MRI using special pulse sequences to reduce metal artefacts. Results One hip was not amenable to analysis. An isolated granulomatous lesion was found in 3 hips, associated osteolysis in 32, in the pelvis only in 10, in the femur only in 3 and in both segments in 19. By zones, the pelvis involvement was supra-acetabular ilium in 15, ischium-pubic branch in 24, ischium in 12 and retro-acetabular ischium in 21. Only two hips and two screws central lesions were isolated from the granulomatous mass. Comments and conclusions MRI osteolysis and soft tissue lesions secondary to wear to be studied. The distribution of osteolytic areas show a peripheral pattern typical of non-perforated acetabular cups frequently coexisting with proximal femoral involvement, highlighting few isolated lesions in the holes or around the implanted screws.

Componente acetabular no cementado en coxartrosis por fractura de cotilo

Objective To evaluate the outcomes of cementless acetabular component for post-traumatic arthritis after acetabular fracture. Material and method A prospective study of twenty-four patients with a mean age of 56 years (range: 28-77) and a follow-up 8.4 years (range: 5-15) treated with cementless total hip arthroplasty. The time from fracture to total hip arthroplasty was 3 years (range: 5 months-14 years). The fracture had been treated conservatively in 15 cases and with internal fixation in 9 cases. A clinical assessment was made using with Harris hip score, along with radiology with special interest in the socket. Results Harris hip score increased from 35 points (range: 22-52) to 77 (range: 45-94). Unstable acetabular fixation was seen in 3 cases, 2 with osteolysis that required revision and 1 with a complete radiolucent line. The stem required revision in 1 case. There was 1 case of deep infection and 1 post-traumatic late dislocation. Survival for any cause at 12 years was 78.4%. Discussion and conclusions There are few studies on this topic, and all with a small number of cases. Acetabular failure rate is higher than routine total hip arthroplasty for non-traumatic osteoarthritis. Cementless total hip arthroplasty is a suitable treatment for post-traumatic arthritis after acetabular fracture.

Is there evidence for a superior method of socket fixation in hip arthroplasty? A systematic review

Total hip arthroplasty has been a very succesful orthopaedic procedure. The optimal fixation method of the acetabular component however, has not yet been defined. We performed a systematic review using the Medline and Embase databases to find evidence for the superiority of cemented or cementless acetabular components on short- and long-term clinical and radiological parameters. Methodological quality for randomised trials was assessed using the van Tulder checklist, and for the non randomised studies we used the Newcastle-Ottawa quality assessment scale. Our search strategy revealed 16 randomised controlled trials (RCT) and 19 non RCT studies in which cemented and cementless acetabular components are compared. A best evidence analysis for complications, wear, osteolysis, migration and clinical scores showed no superiority for either cemented or cementless socket in the RCTs. A best evidence analysis for non RCT studies revealed better osteolysis, migration properties and aseptic loosening survival for cementless sockets; however, wear and overall survival favoured the cemented sockets. We recommend that an orthopaedic surgeon should choose an established cemented or cementless socket for hip replacement based on patient characteristics, knowledge, experience and preference.

Impacted Autograft and Cementless Components in Acetabular Revision: A Retrospective Series

A retrospective review of the short- to medium-term results of acetabular revision using impacted autograft combined with cementless acetabular components is reported. Twenty-five cases with aseptic acetabular loosening and associated bone defects were revised using impacted autograft and a cementless acetabular component. Twenty-five patients were followed for a minimum of 4 years. Mean follow-up was 5.5 years (range 4.0-8.0 years). Radiographs showed that good incorporation of autograft occurred in all cases. Mean Harris hip score improved from 36.0 points (range 20.0 to 50.0) pre-operatively to 85.7 points (range 50.0 to 91.0) at latest follow-up. Outcome was Excellent in 8 cases, Good in 13 cases and Fair in 4 cases. No cases required further revision. The use of impacted autograft in combination with cementless components for acetabular revision can achieve good short- to medium-term result in patients with acetabular bone deficiency.