Selected Instructional Course Lecture   |    
How to Do a Revision Total Hip Arthroplasty: Revision of the Acetabulum
Scott M. Sporer, MD, MS1
1 Department of Orthopaedic Surgery, Rush University Medical Center, 25 North Winfield Road, Suite 505, Winfield, IL 60190.
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Disclosure: The author did not receive payments or services, either directly or indirectly (i.e., via his institution), from a third party in support of any aspect of this work. He, or his institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. The author has not had any other relationships, or engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by the author of this work are available with the online version of this article at jbjs.org.

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Look for this and other related articles in Instructional Course Lectures, Volume 61, which will be published by the American Academy of Orthopaedic Surgeons in February 2012:
• "Femoral Fixation in Revision Total Hip Arthroplasty," by Curtis W. Hartman, MD, and Kevin L. Garvin, MD
Printed with permission of the American Academy of Orthopaedic Surgeons. This article, as well as other lectures presented at the Academy's Annual Meeting, will be available in February 2012 in Instructional Course Lectures, Volume 61. The complete volume can be ordered online at www.aaos.org, or by calling 800-626-6726 (8 a.m.-5 p.m., Central time).

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Jul 20;93(14):1359-1366. doi: 10.2106/JBJS.9314icl
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The most common indications for acetabular revision include instability, infection, polyethylene wear, and aseptic loosening1. The prevalence of these conditions remains essentially unchanged despite improved prosthetic component designs and enhanced surgical techniques. A successful acetabular revision must provide intimate contact between the acetabular implant and the host bone, a stable mechanical construct minimizing micromotion to allow bone ingrowth into a cementless acetabular component, and a mechanical construct that distributes the physiologic stresses to the surrounding acetabular bone. Additionally, the acetabular reconstruction must allow appropriate component orientation to minimize the risk of dislocation and reestablish the anatomic hip center to improve the overall joint kinematics. Biologic methods of acetabular reconstruction are advised except in cases of severe bone loss or prior radiation treatment in the hip region, since nonbiologic revisions eventually fail2. Periacetabular bone loss can compromise component fixation, resulting in early loosening of the revised acetabulum. The amount of bone loss undoubtedly influences the ability to obtain initial optimal fixation. The location of remaining supportive bone, however, has a more important role in providing durable fixation than does the quantity of bone loss.
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