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Acetabular Revision: Overview and Strategy
Revision of the acetabular implant after total hip arthroplasty (THA) was performed for different reasons in previous decades than in the present: wear of the polyethylene liner with periprosthetic osteolysis, late aseptic loosening, recurrent dislocation due to suboptimal acetabular implant position, and infection. Today, many prostheses with conventional polyethylene continue to be revised because they are in their second or third decade of use. Acetabular implants, especially those with more modern designs and additional screw fixation, usually have bony integration and rarely become loose; however, early-generation locking mechanisms and the use of conventional polyethylene predispose these cups to failure. Periprosthetic infection is increasing in incidence, in part because indications for hip arthroplasty have become more widespread, especially in elderly or immunocompromised patients. Finally, the use of metal-on-metal articulations has led to an increased incidence of pain, instability, and infection and has created unique indications for socket revision, such as the need to change the bearing surfaces. This chapter provides an overview of recommended strategies for revision of the acetabular component in hip arthroplasty, including methods for the diagnosis of acetabular cup problems, classification of acetabular bone loss, principles and techniques of reconstruction, and tips for avoiding pitfalls and complications.