Rim-point-column-oriented algorithm in cementless acetabular reconstruction in revision total hip arthroplasty a minimum five-year follow-up study

• Published in: The bone & joint journal Vol. 107-B; no. 6 Supple B; pp. 15 - 22
• Main Authors: Huang, Yong, Zhou, Yixin, Yang, Dejin, Tang, Hao, Deng, Wang, Guo, Shaoyi
• Format: Journal Article
• Language: English
• Published: England 01.06.2025
• Subjects: Acetabulum - diagnostic imaging; Acetabulum - surgery; Adult; Aged; Aged, 80 and over; Algorithms; Arthroplasty, Replacement, Hip - methods; Female; Follow-Up Studies; Hip Prosthesis; Humans; Male; Middle Aged; Plastic Surgery Procedures - methods; Prosthesis Design; Prosthesis Failure; Reoperation - methods; Retrospective Studies; Treatment Outcome
• ISSN: 2049-4394; 2049-4408; 2049-4408
• DOI: 10.1302/0301-620X.107B6.BJJ-2024-0940.R1

The Paprosky acetabular defect classification and associated algorithms cannot adequately guide cementless acetabular reconstruction when using porous metal augments. We aimed to introduce a rim, points, and column (RPC)-orientated cementless acetabular reconstruction algorithm, and hypothesized that patients undergoing this treatment would demonstrate satisfactory mid-term clinical and radiological outcomes. We enrolled 114 patients (119 hips) who underwent revision total hip arthroplasty between April 2014 and November 2017 by a single surgeon. A minimum five-year radiological follow-up was available for 90 hips (75.6%), with mean clinical and radiological follow-up durations of 6.8 years (SD 0.9) and 6.3 years (SD 1.9), respectively. Harris Hip Scores improved from 35.4 (SD 10.2) preoperatively to 86.0 (SD 10.3) postoperatively (p < 0.001). Fixation modes included rim fixation (33 hips; 27.7%), three-point fixation without point reconstruction (42 hips; 35.3%), three-point fixation with point reconstruction (40 hips; 33.6%), and three-point fixation with pelvic distraction (four hips; 3.4%). Medial wall reconstruction was performed in 20 patients (16.8%). All acetabular components were radiologically stable. Nine-year Kaplan-Meier survival rates for periprosthetic joint infection, any reoperation, and dissatisfaction were 98.28% (95% CI 88.38 to 99.76), 94.37% (95% CI 81.93 to 98.33), and 95.10% (95% CI 84.64 to 98.50), respectively. Acetabular component stability in cementless acetabular reconstruction relies on rim or three-point fixation, with anterior and posterior column continuity providing essential stability. Medial wall reconstruction complements fixation in the RPC algorithm, yielding satisfactory mid-term outcomes.