Intracavitary, extracavitary augments may provide support in acetabular reconstruction
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Depending on the type of bone loss, intracavitary or extracavitary augments may provide either secondary or primary support in acetabular reconstruction with major bone loss, according to a presenter.
In his presentation at the Current Concepts in Joint Replacement Meeting, Wayne G. Paprosky, MD, FACS, noted augments can be combined to reduce the defect size or be supplemented with a cup cage. In defects that go “up and out,” surgeons should be aware not to over ream anteroposteriorly prior to placing an intracavitary augment for secondary support, according to Paprosky.
“The augment goes in, the cup is partially supported on the anteroposterior wall, it is fixed with screws and then, it will be unitized with cement,” Paprosky said. “You could put the cup in first and then augment later, but this is how I tend to do most of these and, like I mentioned, we always unitize these with cement to get a good press fit.”
Paprosky added when nothing is left in the intracavitary space to put the augment, an extracavitary augment can be used for secondary support.
When reconstructing the anterosuperior column, Paprosky said to restore the hemisphere, augment superiorly and stabilize the cup.
“We couldn’t get [the cup] stabilized in any way, shape or form without augments,” he said.
Paprosky noted partial weight-bearing is recommended for patients up to 3 months postoperatively.
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Paprosky WG. Uncemented cup plus metal augments: Indications, tips and techniques. Presented at: Current Concepts in Joint Replacement Meeting; Dec. 7-10, 2022; Orlando (hybrid meeting).
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