Introduction 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.
Indications & Contraindications
Step 1: Expose the Acetabulum (Video 1 and Figs. 1-A and 1-B) Perform an extensile approach to the acetabulum.
Step 2: Remove the Existing Acetabular Component (Video 1 and Figs. 2-A and 2-B) Ensure that the appropriate tools are available for removal of the existing acetabular component.
Step 3: Prepare the Acetabulum (Fig. 3) It is important to remove fibrous tissue around the acetabulum to get to healthy bleeding bone.
Step 4: Prepare the Bulk Allograft (Video 2 and Figs. 4-A, 4-B, and 4-C) It is important to remove all of the native cartilage from the graft to allow for osseous ingrowth potential.
Step 5: Place the Bulk Allograft into the Acetabular Defect and Fill Excess Space with Allograft Chips Ensure that the graft properly fits within the acetabular defect.
Step 6: Secure the Graft to the Acetabulum and Ream the Allograft It is important to stabilize the bulk allograft to the pelvis before reaming.
Step 7: Implant the Cage (Video 4 and Figs. 9-A, 9-B, and 9-C) Impact the cage implant into position and secure it to the pelvis with as many screws as necessary to obtain a secure implant.
Step 8: Cement the Polyethylene Cup and Perform Trial Reduction of the Hip Cement the polyethylene cup in the proper orientation and reduce the hip.
Results We reviewed 72 cage constructs in 68 patients at a mean follow-up of 5.1 years (range, 1.2 to 10.7 years)3.
Pitfalls & Challenges
The use of a massive allograft along with an antiprotrusio cage for the treatment …
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