A modified custom-made triflanged acetabular reconstruction ring (MCTARR) for revision hip arthroplasty with severe acetabular defects.

The treatment of extensive acetabular bone loss and pelvic discontinuity in revision total hip arthroplasty remains challenging. We report our preliminary experience with the modified custom-made triflanged acetabular reconstruction ring (MCTARR) in the management of such situations. The MCTARR is a custom-made metal reinforcement ring with a trabecular surface to encourage bone ingrowth and a bulky trabecular metal augmentation to fill the acetabular defects, designed to achieve initial and long-term stability. A custom-made drilling jig is used to achieve optimal screw positioning. The clinical and radiological short-term follow-up (10-58 months) of our first six cases treated with this new technique show acceptable to good results. None of the reconstructions failed or had to be revised. Clinical results were satisfactory. Radiographs showed good screw positioning. The custom-made acetabular drilling jig and the reconstruction of the acetabulum with a titanium porous structure are of added value in the treatment of severe acetabular bone loss and pelvic discontinuity with custom-made triflanged components.

Inverted cup prosthesis to treat recurrent hip dislocation in frail elderly patients.

Recurrent hip dislocation has become an increasing problem in patients who had multiple component revision in total hip arthroplasty. These are often frail elderly patients with loss of constraining soft tissue envelope around the hip and an excessive weakness of the abductor mechanism. We present a simple technique for open reduction of a dislocated hip using a custom-made fully constrained construct with potential for preserving the well fixed femoral implant and parts of the acetabular component. The custom-made constrained construct consists of the application of an inverted cup over the femoral neck or head, the cup being fixed to the acetabular insert with screws. Three frail elderly patients have been successfully treated. One specific case is described in detail. In frail elderly patients who may have undergone several revision surgeries, it is important to preserve components of the total hip replacement when possible. The proposed technique may be an alternative solution for these patients.