Wayne G. Paprosky, MD
Primary long-term complication of total hip arthroplasty is migration or loosening of the acetabular component. A complex reconstruction of the acetabulum provides a surgical solution to this complication; however, developing a surgical plan for the acetabular reconstruction can be a complex undertaking, especially when bone deficiency is present.
Analysis of preoperative X-rays provides clues of anteromedial bone loss, lysis in the ischium, and extent of cup migration or loosening. A decision must be reached regarding whether a porous-coated acetabular component can be used, which requires that at least 50% host bone be available for direct contact or coverage. If the amount of migration of the acetabular component indicates that bone loss may be more extensive, alternatives must be considered, such as a pelvic reconstruction ring, a cemented metal shell, or an all-polyethylene component.
In this segment, Dr. Wayne G. Paprosky describes the roentgenographic findings that point to severe bone deficiency in the acetabulum. The case involves a woman with rheumatoid arthritis, in whom the acetabular component had migrated through the inner wall of the pelvis with severe bone loss and increasing pain. In addition, the femoral component had loosened and required revision.
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- Younger TI, Magnus RE, Paprosky WG Extended proximal femoral osteotomy A new technique for femoral revision arthroplasty J Arthroplasty 1995;10(3):329-338
- Berlin KC, Freeman MR, Morscher E, Oeri A, Ring PA Cementless acetabular replacement using a pegged polyethylene prosthesis Arch Orthop Trauma Surg 1985;104:251-261
- Total Run Time: 23:38 minutes
- Catalog Number: 4040
- VJO Publication Date: June, 1996