This chapter presented our own experience for acetabular defects reconstruction. 56 patients were operated during the research period: 26 - primary hip replacement and 30 patients with revision hip (Fig 3.1).
Only W.G. Paprosky classification was used to classify acetabular defects during our investigation (Fig. 3.2).
Different kind of tantalum constructions were used to reconstruct existing acetabular defects during replacement surgery.
Porous tantalum is an alternative metal for total joint arthroplasty components that offers several unique properties. Its high volumetric porosity (70% to 80%), low modulus of elasticity (3 MPa), and high frictional characteristics make it conducive to biologic fixation. Tantalum has excellent biocompatibility and is safe to use in vivo. The low modulus of elasticity allows for more physiologic load transfer and relative preservation of bone stock. Because of its bioactive nature and ingrowth properties, tantalum is used in primary as well as revision total hip arthroplasty components, with good to excellent early clinical results. In revision arthroplasty, standard and custom augments may serve as a structural bone graft substitute.
Now some patients’ X-rays will be presented before and after operation and we will try to make a conclusion according to this experience.
In the Fig. 3.3 was presented the patient with II B acetabular defect (cavitary acetabular defect) according W.G. Paprosky - primary hip replacement. In the preoperative X-Ry and 3D picture possible to see bone deficiency in superiorlateral part of acetabulum. In the postoperative X-Ry and 3D picture (Fig. 3.4) existing defect was covered with tantalum augment. Between augment and cup bone cement was used.
In the Fig. 3.5, 3.6 again possible to see II B defect (segmental acetabular defect) according Paprosky classification, before and after operation. This case presented revision hip replacement. In preoperative X-Ry we can see acetabular cup failure after cemented fixation.
Next patient, Z.D.Y., 47 years old, was operated with III A defect (extensive segmental acetabular defect) – primary hip replacement. In the Fig. 3.7, Fig. 3.8 possible to see preoperative and postoperative X-Rys, 3D pictures.
In next case also possible to see III A acetabular defect (Fig. 3.9). Patient had bone deficiency in the central part of acetabulum.
During next three cases we want to present patients with III A and B acetabular defects with severe bone loosening.
The first patient had dislocation after replacement surgery and instability for all component of endoprosthesis. In Fig. 3.10 we can see X-Ry before operation and after the first operation. Aim of the first operation was removing previous prosthesis and putting spacer. There was huge bone defect in acetabular region, III B (Fig. 3.10 B, Fig. 3.11). In Fig. 3.12 possible to see acetabular defect reconstruction with tantalum augment, during the surgery A (intraoperative pictures) and after surgery B (postoperative X-Ry).
The second case – 32 years old patient, Y.W.Z., after acetabular region plating operation. Patient had deformity in the hip joint and severe pain. In Fig. 3.13 possible to see preoperative X-Rys, III A defect according to W.G. Paprosky classification and in Fig. 3.14 – postoperative X-Rys, after the reconstraction surgery with tantalum construction.
The third patient – 73 years old female, H.Y.Z., after bilateral hip replacement (Fig. 3.15). In the right side possible to see huge bone defect (III B) in the acetaular region, cup loosening and fracture, in the left side also bone defect and cup loosening. Fig. 3.16 presented tantalum augments preparation with using bone cement. In the Fig. 3.17 we can see postoperative X-Rys, after the right acetabulum reconstruction with augments and in the Fig. 3.18 possible to compare difference between using cup cage technic and tantalum augment.
During research period we had three patients with complications (Fig. 3.19): two cases of dislocation after revision replacement (3,6%) and one - after primary replacement (1,8%) (Fig. 3.20), one suppuration case (1,8%) (Fig. 3.21).