Acetabular defect classification and management: Revision arthroplasty of the acetabular cup based on 3-point fixation

BACKGROUND: The purpose of this study was to provide a practicable and contemporary classification system that is reliable and pragmatic with respect to perioperative evaluation, planning, scientific comparison and analysis. MATERIAL AND METHODS: This was a retrospective study of 160 patients who underwent acetabular revision surgery after THR due to loosening of the acetabular cup. The assessment of the acetabular defect was based on intraoperative description of the bony configuration of the acetabulum as well as on standardized preoperative planning images (pelvic overview and axial view of the hip joint). Preoperative computed tomography (CT) was carried out in individual cases. RESULTS: Acetabular bone defects were classified into 4 types based on whether or not a 3-point fixation of the acetabular cup within the boundaries of the acetabular cavity was possible. Minor segmental defects or cup loosening without bone loss can be treated with standard hemispherical acetabular components. Bone loss can be filled with bone grafts and/or treated by the appropriate acetabular component in order to ensure stable anchorage. When conventional revision cups are no longer suitable a custom made partial pelvic replacement can be used. CONCLUSION: The proposed classification mainly relies on intraoperative findings which were confirmed by preoperative imaging in 154 cases out of 160 (96.25%); however, meticulous preoperative planning based on X‑ray radiographs must be carried out. In addition, a CT scan must be performed whenever type III or type IV defects are anticipated. Compared to the existing classification systems, we can state that our classification system is practicable and pragmatic and simplifies the assessment of bone defects.