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. 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.
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. 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.