This retrospective case series reports long-term outcomes for 17 of the most complex acetabular reconstructions in revision THA: type III major column defects and type IV pelvic discontinuity. Bulk allograft with pelvic reconstruction plating was the primary technique. The study asks whether this construct can durably restore stability and fixation in the most severe acetabular deficiency scenarios.
Before this era, surgeons had limited systematic data on the very worst acetabular defects in revision THA — type III column loss and type IV pelvic discontinuity were managed inconsistently, with no consensus on fixation strategy or approach selection.
This paper crystallizes two decision rules that persist in practice today. First: when more than 50% of the cup interface rests on nonviable allograft, cement the component. Press-fit into dead bone predictably fails. Second: avoid the extensile triradiate approach in elderly or high-risk patients. A 50% dislocation rate is not a trade-off worth making when an antiprotrusio cage or excisional arthroplasty will suffice.
The AAOS acetabular defect classification (Types I–IV, with IVA/B/C subtypes for pelvic discontinuity) used throughout this paper is the framework you need to know for boards and for preoperative planning in any complex acetabular revision.
This retrospective case series reports long-term outcomes for 17 of the most complex acetabular reconstructions in revision THA: type III major column defects and type IV pelvic discontinuity. Bulk allograft with pelvic reconstruction plating was the primary technique. The study asks whether this construct can durably restore stability and fixation in the most severe acetabular deficiency scenarios.
Before this era, surgeons had limited systematic data on the very worst acetabular defects in revision THA — type III column loss and type IV pelvic discontinuity were managed inconsistently, with no consensus on fixation strategy or approach selection.
This paper crystallizes two decision rules that persist in practice today. First: when more than 50% of the cup interface rests on nonviable allograft, cement the component. Press-fit into dead bone predictably fails. Second: avoid the extensile triradiate approach in elderly or high-risk patients. A 50% dislocation rate is not a trade-off worth making when an antiprotrusio cage or excisional arthroplasty will suffice.
The AAOS acetabular defect classification (Types I–IV, with IVA/B/C subtypes for pelvic discontinuity) used throughout this paper is the framework you need to know for boards and for preoperative planning in any complex acetabular revision.