Treatment options for large acetabular defects in hip revision surgery:current options and a custom-made solution

Total hip arthroplasty is referred to as the operation of the century. In this thesis the current treatment options for large acetabular defects are evaluated and a new acetabular implant to treat large acetabular defects is introduced and evaluated. A review of the literature on the current treatment options for large acetabular defects is presented. It showed that Trabecular MetalTM (Zimmer) augment and shells gave the most promising results. Reconstruction with an antiprotrusio cage was the most frequently reported technique, with good results in a physically low demand elderly population. Bone impaction grafting seems not appropriate for pelvic discontinuity and Paprosky type-3B defects. In those cases, a custom-made triflange implant or a cup-cage reconstruction might be the best alternative, but few reports of sufficient quality are available yet. Next a new custom-made acetabular implant for large acetabular defects is introduced including its surgical technique. The accuracy of the placement of the implant is evaluated in a group of 16 patients. This first group is then compared to a second group of 16 patients. The results are promising and a trend towards better surgical accuracy and less complications in the second group is found, despite a higher complexity in cases. Finally, the clinical and radiological follow-up at two years is described using a prospective case series of 50 hips. It shows that this custom-made acetabular implant is a viable option for uncontained acetabular defects and pelvic discontinuity