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Acetabular Revision: Structural Grafts and Metal Augments
Structural allografts can be used to restore bone stock deficiency in revision total hip arthroplasty. Although allograft bone can be used in contained and uncontained defects, structural allografts should be reserved for the management of uncontained bone defects in which the host bone contact is less than 70%. In patients with host bone contact between 50% and 70%, a minor column graft is indicated. In patients with host bone contact less than 50%, a major column graft should be used with a cage construct to protect the bone graft. The goals of the use of structural allografts are to restore bone loss, maintain the anatomic hip center of the revision shell, and improve stability of the acetabular construct. Structural allografts are especially useful in younger patients (age 40 years or younger), in whom restoration of bone stock may help with future repeat revision of the acetabular implant. Overall, the use of structural allografts in acetabular revision provides a reasonable strategy for addressing bone loss. However, the disadvantages of structural allografts are concerns of allograft resorption, infection, and loosening of the construct. This chapter reviews the indications, contraindications, results, and techniques related to the use of structural allografts in revision total hip arthroplasty. Tips for avoiding pitfalls and complications are also provided.