Acetabular revision with allograft bone: 103 revisions with 3 reconstruction alternatives, followed for 0.3–13 years

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Abstract
We reviewed 103 consecutive acetabular revisions in 92 patients, for whom allograft bone and 1 of 3 alternative acetabular components had been used: Har-ris-Galante cup (HGC, 38 hips), Müller acetabular roof reinforcement ring (ARR, 39 hips), or Burch-Schneider antiprotrusio reinforcement cage (APC, 26 hips). The mean follow-up was 4.5 (0.3–13) years. 7 HGCs, 1 ARR, and 1 APC required revision because of aseptic loosening. Using the endpoint revision because of such loosening, the HGC gave 73% survival after 8 years, the ARR 89% after 13 years, and the APC 94% after 11 years. Using a worst-case criterion, survival was 69% for the HGC after 8 years, 84% for the ARR after 13 years, and 83% for the APC after 11 years. Radiographic incorporation of the allograft, no resorption of the allograft, use of a bulk allograft, male gender, and implantation of a reinforcement device were associated with a lower mechanical failure rate. Good durability of allograft bone in reconstructions of bone deficiencies in acetabular revision surgery can be expected when the implant can bridge the temporary period of mechanical weakness of the allograft. Therefore, in severe acetabular deficiencies, reinforcement devices with sufficiently stable fixation in the host bone should be preferred.