One hundred and thirty-eight consecutive revisions of an acetabular
component were performed in 132 patients between 1983 and 1986. The
revision prosthesis was a hemispherical component that was coated with
porous titanium mesh and was secured to the pelvis with a variable number
of screws. There were seventy-five women and fifty-seven men, and the mean
age at the time of the revision was fifty-two years (range, twenty to
seventy-nine years). Due to defects in the acetabulum, 80 per cent of the
hips were treated with bone grafts, usually a mixture of local autogenous
graft and freeze-dried allograft. One hundred and twenty-four patients (129
hips) were available for follow-up, at a mean of forty-four months (range,
thirty-six to eighty months). Seven hips (5 per cent) were revised again:
four because of infection and three because of instability. There were no
revisions for loosening without infection, and none of the components
migrated in the absence of infection. Radiolucent lines were common and
usually corresponded to regions in which allograft had been used. All bone
grafts united by twelve months. Non-contained medial grafts underwent a
phenomenon of resorption, consolidation, and remodeling to a sclerotic rim
by twenty-four months. There were no complications related to placement of
the screws. The results in this series were superior to results of
revisions of acetabular components with the use of cement, which were
associated with rates of failure of almost 10 per cent after a similar
duration of follow-up. The technique of maximization of host-bone coverage
and of packing of all defects with cancellous autogenous graft or
allograft, or both, was successful for all classes of acetabular
deficiencies.