Acetabular wall deficiency in primary and secondary total hip replacement.

Thirty-eight cases of reconstruction of acetabular wall deficiency in primary and secondary total hip replacement were evaluated according to Merle d'Aubigne-Postel and Gruen's ratings, after a follow-up of between 1 and 8 years. 16 of them were considered very good, 11 good, 7 fair and 4 poor.The reconstructions were performed by inserting cemented Weller's or cementless Parhoffer-Mönch's or Mittelmeier's cups, depending on patients age and the nature of the lesion.In dysplastic hips the bone stock deficiency of the anterior wall and the roof were reconstructed with the use of massive autogenous cortical bone graft fixed with screws.In cases of Otto-Chrobak disease and in protrusions of Austin-Moore's prostheses, cancellous auto- or allogenous bone grafts healed correctly even after implantation of cemented sockets.The reconstruction of the acetabulum in an intrapelvic protrusion of the endoprosthesis, especially cemented ones, was always technically difficult, threatening the vessels and intrapelvic organs. This operation requires good experience as well as:-thorough radiographic diagnosis (CT, angiography external iliac artery and vein),-an appropriate surgical approach,-the use of a sufficient amount of cortico-cancellous bone auto- or allograft,-implantation of cemented or cementless cups depending on the patient's age,-restriction of weight-bearing even up to 5 months. In old patients, an alternative to full reconstruction is to remove the endoprosthesis and to leave a hanging hip (Girdlestone pseudarthrosis).