How to do a revision total hip arthroplasty: revision of the acetabulum.

The need for revision total hip arthroplasty continues to increase as the indications for total hip replacement broaden and the average life expectancy of patients and their demands for activity increase. To achieve a successful long-term outcome after revision acetabular surgery, the surgical reconstruction must provide a mechanically stable construct that will minimize micromotion, allow bone ingrowth, and restore appropriate hip biomechanics. Achieving these goals during revision acetabular surgery can be challenging because of periacetabular bone loss and a compromised biologic environment. Acetabular classifications can help to preoperatively predict areas of bone loss to guide treatment options. Most acetabular defects can be managed with a hemispheric or elliptic porous acetabular component; however, large areas of segmental or cavitary bone loss may require alternative treatments such as custom implants, metal/allograft augmentation, or an acetabular cage reconstruction.