BMP复合仿生人工骨填塞犬股骨假体周围髓腔骨缺损的实验研究

目的评估仿生人工骨（PLGA／TCP）材料作为BMP缓释系统载体材料修复犬假体涂层多孔钛周围骨缺损的可行性。方法给予8只犬进行右侧股骨头置换术，并充分扩髓，周围填充BMP复合的PLGA／TCP骨移植材料，应用X线拍片、组织和荧光观察、EDX及SEM检测、骨密度定量分析等方法，观察负重情况下该材料的实际效果。结果术后X线显示，未有出现透亮带、无假体下沉，未见骨质吸收；20周时骨与假体之间紧密接触，多孔钛内骨组织明显长入，以编织骨为主。植入的活性人工骨已经完全降解，骨小梁结构成熟；假体植入肢体与非手术肢体骨密度之比，显示在术后1个月假体植入侧的骨密度值有所降低，而后逐渐升高。结论多孔钛涂层有助于假体内骨与假体的固定，BMP复合PLGA／TCP作为新的骨移植材料应用于关节外科，有广泛的潜力和价值。     

全髋关节翻修术中髋臼假体的选择和髋臼骨缺损的处理

目的探讨全髋关节翻修术中髋臼假体的选择和髋臼骨缺损的处理。方法2002年1月至2007年6月收治资料较完整的全髋关节翻修术患者共55例，其中行髋臼假体翻修术的患者有36例，男8例，女28例；年龄52～86岁，平均73岁。左髋13例，右髋23例。髋臼翻修原因：髋臼假体松动20例，髋臼和股骨假体均有明显松动12例；头臼不匹配2例；髋臼假体位置不良导致复发性脱位2例。髋臼骨缺损21例，按照美国矫形外科学会（AAOS）分类标准：Ⅰ型：节段性骨缺损6例；Ⅱ型：腔隙性骨缺损9例；Ⅲ型：混合型骨缺损6例。结果36例中，4例仅翻修髋臼侧假体，保留原股骨假体；3例更换了磨损严重的聚乙烯内衬，未予更换金属假体，其余29例均行全髋关节置换翻修术。髋臼骨缺损21例中，6例使用颗粒骨打压植骨＋骨水泥假体，2例为结构性和颗粒性打压植骨＋骨水泥假体，9例为结构性植骨＋颗粒打压植骨后，使用金属加强环＋骨水泥假体，1例为结构性植骨后，使用常规髋臼假体，3例仅对局部骨缺损部位进行植骨未予更换稳定的金属假体。随访时间6～68个月，平均39个月。Harris评分由术前的平均48分，提高至随访时平均89分。结论机械性磨损是人工髋关节松动翻修的主要原因；翻修时，假体的选择和骨缺损的处理要根据患者个体情况差异和术中具体情况综合考虑；周密的术前计划、准备多种类型髋臼假体供术中选择、充分自体和异体植骨是保证手术顺利进行的根本。     

A long-term study on defect filling and bone ingrowth using a canine fiber metal total hip model.

When performing primary and revision total hip arthroplasty (THA), bone defects are often encountered. At present, grafting osseous defects with autogeneic bone is a common means of treatment. In this study, defects in bone were created in the femora and acetabula of dogs being treated with cementless THA with a fiber metal implant (Group A) or a hydroxyapatite tricalcium phosphate (HA/TCP) sprayed implant (Group B). The following methods of defect filling were compared: (1) leaving defects unfilled, (2) filling with autogeneic bone graft, (3) filling with a 50:50 mixture of autograft and a biphasic ceramic composed of HA/TCP, and (4) filling with a collagen-HA/TCP-bone marrow mixture. Analysis of defect healing and the extent of ingrowth into the overlying fiber metal, at defect sites and sites distant from defects, was made at six, 12, and 24 weeks postimplantation. Defect healing was enhanced at six and 12 weeks in all grafted groups when compared with ungrafted controls. Bone ingrowth into the porous fiber metal overlying the defects was not significantly affected by grafting the defects, compared with the ungrafted defects. The extent of bone ingrowth into the fiber metal acetabular implant at sites away from the defects increased during the entire study. In contrast, the extent of bone ingrowth on the femoral side was maximal at 12 weeks. The HA/TCP coating enhanced ingrowth into the acetabular component at 12 weeks, compared with the uncoated prosthesis, but did not enhance ingrowth on the femoral side. The data from this study demonstrate that defect healing is enhanced with graft materials. However, this does not necessarily result in increased ingrowth into porous surfaces overlying osseous defects. General bone ingrowth and ingrowth at defect sites at 12 weeks postimplantation can be enhanced on the acetabular side with the use of HA/TCP-sprayed implants. However, no positive effect is seen with the use of an HA/TCP-sprayed femoral implant.     

Porous-coated femoral components in a canine model for revision arthroplasty

Six dogs had a total hip arthroplasty during which the femoral component was coated with methacrylate and inserted in the femoral canal, after the canal had been reamed to a larger diameter than that of the femoral stem (including the coating). Thus, the implant was loose and motion was present between it and the femur in each animal. Five dogs had a revision to a prosthesis with a porous polysulfone-coated stem. This prosthesis was not cemented in place. One dog was killed before the revision for the purpose of histological examination. Although bone was present in the porous surface of all five stems at the revision, the amount was scant in three. CLINICAL RELEVANCE: A model is described for the study of cemented hip-replacement prostheses that have failed. Although variable amounts of ingrowth of bone were observed after the revision to the porous-coated prostheses without bone cement, further study is needed to determine whether adequate ingrowth of bone occurs in this model.     

Strukturelle Femurkopfallografts in der Revisionschirugie von gelockerten Hüftendoprothesenpfannen

BACKGROUND: Treatment of acetabular bone defects presents a great challenge in revision total hip arthroplasty (THA). Many methods of acetabular reconstruction have been described. The purpose of this study was to evaluate the midterm results of structural femoral head allografts for acetabular reconstruction. METHODS: Thirty-six patients (33 females and 3 males) with acetabular defects ranging from type 2C to type 3B according to Paprosky's classification were included in the study. In all cases acetabular defects were closed using allografts from femoral heads. In 13 cases an uncemented press-fit cup, in 17 cases a cemented polyethylene socket, and in 6 cases a Burch-Schneider antiprotrusion cage was implanted. The mean follow-up period was 84.2 months (range: 5-147). RESULTS: Four acetabular components failed. All 36 grafts were osseointegrated radiographically and formed a mechanically stable construction. The mean Harris Hip Score at the most recent follow-up was 79.8 points. The distance from the obturator line to the prosthesis head center was 3.73 cm (1.17-5.80 cm) preoperatively and 2.79 cm (0.85-4.8 cm) postoperatively (p<0.05). The distance from the teardrop figure to the prosthesis head center was 3.02 cm (1.0-5.8 cm) preoperatively and 3.25 cm (1.6-4.8 cm) postoperatively (p<0.001). CONCLUSIONS: Closure of acetabular defects of types 2C to 3B according to Paprosky's classification can be satisfactorily accomplished using femoral head allografts. These allografts may facilitate future revision surgery. Femoral heads are readily available due to widespread primary total hip replacement surgery. However, the use of structural femoral head allografts for acetabular reconstruction is cost intensive. Individual patient-related aspects, such as the function of revision arthroplasty, have to be considered when planning revision arthroplasty using femoral head allografts.     

The efficacy of BMP-2 to induce bone ingrowth in a total hip replacement model

The purpose of this canine total hip arthroplasty (THA) study was fourfold: (1) to quantify the efficacy of rhBMP-2 in a carrier (alphaBSM) versus alphaBSM alone, and versus untreated controls to induce bone formation across a defect between a porous acetabular component and host bone; (2) to quantify whether rhBMP-2/alphaBSM improves bone growth into the porous surface beneath that defect; (3) to quantify the efficacy of rhBMP-2/alphaBSM in inducing bone ingrowth into the porous layer at points of intimate bone-implant contact; and (4) to determine whether rhBMP-2/alphaBSM placed in the lateral uncovered aspect of the porous acetabular component promotes de novo bone formation. Fifteen dogs were sacrificed 12 weeks after uncemented THA. Five dogs received rhBMP-2/alphaBSM, five dogs received alphaBSM, and five dogs were controls. In contrast to the controls in which no bone filled the defect, the rhBMP-2/alphaBSM induced defect filling and full bone formation in the underlying porous coating. The alphaBSM produced an intermediary response. However, no increase in new bone formation occurred at sites of intimate bone porous surface contact. Recombinant bone morphogenetic protein-2/alphaBSM promoted defect filling and bone ingrowth into the porous coating beneath the defect region, both of potential value in future total joint replacement surgery.     

Revision arthroplasty with use of a total femur prosthesis

BACKGROUND: Surgeons performing revision arthroplasties of the hip and knee are confronted with a growing number of patients with extensive loss of bone stock. Implantation of a total femur prosthesis is a possible method of treatment of such patients. The purpose of this study was to assess the functional outcomes and the complications associated with total femur replacements used in revision arthroplasty. METHODS: We evaluated the results associated with 100 total femur prostheses that had been implanted during revision arthroplasty in 100 consecutive patients without infection. The mean duration of follow-up was five years. The prosthesis was implanted because of a complication of a total hip replacement in seventy-seven patients, because of a complication of a total knee replacement in four, and because of a complication affecting the diaphysis of the femur in nineteen. Thirty-nine patients had sustained a periprosthetic fracture, usually in combination with loosening of the prosthesis, before the revision. The radiographs made at the time of the latest follow-up were evaluated for signs of loosening and material failure. The preoperative and postoperative function of the hip and knee was assessed according to the Enneking score. Five patients were lost to follow-up. RESULTS: Sixty-five patients (68%) had no complications. Deep infection was found in twelve patients (13%); dislocation, in six (6%); material failure, in three (3%); patellar problems, in two (2%); and peroneal nerve palsy, in one (1%). The mean preoperative Enneking score for hip function was 1.25 points, and it improved to 3.29 points postoperatively. The mean Enneking score for knee function was 2.09 points preoperatively and 3.29 points postoperatively. CONCLUSIONS: We believe that the total femur prosthesis is a useful implant for patients with extensive bone loss at revision arthroplasty. While the infection rate was high, the overall functional results for both the hip and the knee were rated as better than good with the Enneking classification.     

全髋关节翻修术中髋臼骨缺损的处理方法

目的探讨全髋关节翻修术中对于髋臼骨缺损重建的方法及其术后疗效。方法回顾性分析自2007-03—2011-12的75例（76髋）全髋关节翻修术,髋臼骨缺损根据Paprosky分型：Ⅰ型9髋,ⅡA型21髋,ⅡB型18髋,ⅡC型11髋,ⅢA型10髋,ⅢB型7髋。髋臼骨缺损采用不同方式修复,术后定期随访。采用髋关节功能Harris评分评估髋关节功能,根据X线片判断假体是否松动、植骨是否融合。结果 75例（76髋）均获得平均36（16~73）个月随访。术后12个月不同类型骨缺损患者髋关节功能Harris评分较术前明显提高,差异有统计学意义（P〈0.05）。术后症状和关节功能明显改善,未出现髋臼骨折、感染、下肢深静脉血栓形成、坐骨神经损伤等严重并发症。X线片可见移植骨与宿主骨质交界处有连续性骨小梁通过,假体未见松动迹象。结论髋臼假体无菌性松动及骨溶解是需要进行全髋关节翻修的主要原因,而髋臼骨缺损Paprosky分型法对髋臼翻修重建方法有指导意义,正确选择假体类型及合理选择植骨方式是全髋关节翻修术后取得满意疗效的保证。     

Principles of reconstruction in revision hip arthroplasty: Technique and results of bone grafts for treatment of femoral and acetabular deficits

Revision total hip arthroplasty is usually complicated by bone loss associated with osteolysis secondary to polyethylene debris or defects caused by migration of loose components. This bone loss manifests itself in a variety of femoral and acetabular defects which need to be classified and managed appropriately, due to the variance in results associated with revision arthroplasty. Cementless revision of these defects has demonstrated positive results. A calcar bearing prosthesis was utilized successfully in several grades of deficient femurs with impressive results. In the first study, 264 patients with minimally deficient femurs were treated with a calcar bearing prosthesis. An average follow-up of greater than 5 years (range, 3–10 years) exhibited a 4% revision rate. In a second study, in which cortical strut allografts were used to correct larger femoral defects, a similar follow-up yielded a 2.4% revision rate. The revisions in these series were usually a result of undersizing or attempting to support the prosthesis with graft material. Acetabular deficiencies are also successfully managed with graft material. In the natural acetabulum, most of the support comes from the cortical struts. The acetabulum is fairly easy to revise if the cortical structure is present. Acetabular reconstruction with structural bone loss is possible, but much more technique-dependent. Guest Lecture presented at the 26th meeting of the Japanese Society for Replacement Arthroplasty in Tokyo on February 2, 1996     

人工全髋关节置换翻修术术前假体松动的回顾性研究

目的通过对48例人工全髋关节置换翻修术术前资料的系统回顾性研究,评价采取不同固定方法的假体的临床疗效。方法笔者对行髋关节置换的48例实行了全髋翻修术,并对全部病例进行了术前X线评价及术中假体松动情况调查,并做χ2检验,判断不同假体固定方式对假体寿命的影响。结果早、中期假体松动主要为非骨水泥型假体。骨水泥固定的假体与非骨水泥固定的假体远期均存在很高的松动下沉率,以骨水泥臼的松动为多数。髋臼侧骨溶解发生率以Ⅰ区为高,股骨柄侧骨溶解发生率以股骨近端为最高。结论人工全髋关节置换术中生物性固定初期并不十分牢固。人工全髋关节置换术中骨水泥固定假体松动主要发生在远期,并且以髋臼侧骨水泥松动为主。     

The fate of cementless jumbo cups in revision hip arthroplasty

We report 5-year minimum results of cementless over-sized cups used in revision hip arthroplasty, with significant associated bone defects. Forty-three porous-coated jumbo cups were used to treat acetabular defects in revision hip arthroplasty in 42 patients with a mean age of 63 (range, 25-86). Morsellized allograft only was used in 27 hips, and bulk allograft was used in 8 cases. Two patients were lost to follow-up, and 5 died after a mean 7 years' follow-up, with retention of their prostheses. In the remaining 36 cases, the mean follow-up was 10 years (range, 6-14 years). Two acetabular components were revised for aseptic loosening and graft resorption. Two cases were complicated by dislocation. A satisfactory 92% Kaplan Meier shell survival rate was seen at 14 years.     

The incorporation of morselized bone grafts in cementless acetabular revisions

The treatment of large osteolytic lesions is a challenge during acetabular revisions. Periprosthetic bone loss can compromise the stability of new implants. The purpose of this study was to evaluate the 5- to 10-year clinical and radiographic results of morselized bone grafting for acetabular osteolysis during cementless acetabular revisions. Ninety-nine patients (108 hips) who had an acetabular revision hip arthroplasty for osteolysis were retrospectively reviewed. There were 44 men and 55 women who had a mean age of 66 years. At the index revision, the acetabular defects were debrided of granulomatous tissue and packed tightly with morselized cancellous femoral head allograft. All the revision acetabular components were implanted using cementless fixation. At a mean followup of 85 months (range, 60-118 months), the results of 103 of 108 hips (95%) were clinically and radiographically successful. The mean preoperative Harris hip score was 37 points, which improved to a mean of 91 points at the last followup. All cavitary defects had complete radiographic incorporation of the bone grafts except for two lesions. The results of this study indicate that morselized bone graft incorporates into cementless acetabular revisions. This treatment method provided a stable reconstruction in 98% of patients at a mean of 7 years followup.     

应用S-ROM全髋关节置换术治疗Crowe Ⅳ型髋臼发育不良

目的总结采用粗隆下截骨和生物固定型带股骨柄模块的人工关节假体治疗CroweⅣ型髋臼发育不良伴骨关节炎的效果及经验。方法回顾从2004年2月到2009年4月对12例21髋CroweⅣ型髋臼发育不良伴骨关节炎患者治疗的详细过程及疗效,记录所有的并发症。全部采用粗隆下截骨和S-ROM生物固定型人工关节假体置换术进行治疗。髋臼杯假体均植入真臼位置,7例13髋采用自体股骨头于髋臼外上方作结构性植骨,均作了粗隆下缩短截骨术,平均截骨长度为39.4 mm(35~50 mm)。结果平均随访30.8个月(6~62个月)。髋关节Harris评分明显改善(t=24.862,P0.01),从术前的平均(38.2±6.4)分(28~48分)到术后平均(82.1±8.6)分(62~94分)。术后肢体均得到不同程度的延长(t=12.099,P0.01),平均(33.5±12.7)mm(11~65 mm)。术前所有患者均有明显跛行,术后4例有轻度跛行,2例仍需扶双拐行走。19髋股骨截骨处愈合良好,2髋截骨处延迟愈合。在最后一次回访时显示髋臼假体和股骨柄假体位置均良好,无松动、下沉、断钉、骨溶解及异位骨化出现。髋关节中心平均下移了73.0 mm(46~105 mm)。结论利用S-ROM带股骨柄模块的生物固定型人工关节假体的高度适配性,加上在真臼位置加深髋臼,适当植骨,以及精确的粗隆下截骨,是治疗CroweⅣ型髋臼发育不良伴骨关节炎的良好选择。     

The fate of revised uncemented acetabular components in patients with rheumatoid arthritis

The results of patients with rheumatoid arthritis who had revision hip arthroplasty have been studied infrequently. The purpose of this study was to review the authors' clinical and radiographic experiences and outcomes with revision hip arthroplasty. Revision total hip arthroplasties were done on 28 patients (30 hips). All hips had morselized bone grafting and four hips had bulk allografts for segmental defects. The mean age of the patients at the time of surgery was 50 years (range, 20-74 years). Patients were followed up for 4 to 15 years (mean, 7 years). At the latest followup, 14 hips (13 patients) of the 30 hips (47%) had good and excellent Harris hip score ratings. Mechanical failures included six hips (five patients) that had revision arthroplasty and two hips (two patients) that had resection arthroplasty. Six other hips (five patients) had poor Harris hip score ratings. The Kaplan-Meier survivorship curve for failure of the acetabular component revealed an 89% chance of survivorship curve for failure of the acetabular component revealed an 89% chance of survival at 60 months and a 44% chance of survival at 108 months. Based on the results of this study, revision hip arthroplasty for acetabular loosening with a cementless acetabular prosthesis has a low rate of success in patients with rheumatoid arthritis.     

髋关节翻修术中髋臼骨缺损的处理与重建

目的探讨髋关节翻修术中髋臼骨质缺损的处理和重建方法。方法对28例髋关节置换术后髋臼骨缺损的患者进行翻修,观察术后随访X线片上的髋臼假体及周围骨质变化情况,并对髋关节行Harris功能评定。结果 28例均获随访,随访时间12～184个月,平均61.6个月。1例术后出现脱位,2例术后出现骨溶解并伴患髋疼痛。7例术后随访的X线片上出现髋臼的骨溶解,但髋臼假体无松动表现,患髋无疼痛,患髋功能不受影响。至末次随访为止,25例髋（89%）获得良好的稳定性。术前Harris评分平均31.8分（14～57分）,末次随访时平均85.2分（46～99分）。两组数据具有显著性差异。结论充分的术前准备是手术顺利进行并获得良好效果的一个重要前提,植骨的方式和翻修假体的选择还需结合术中对骨缺损的评价。髋臼假体表面被自体骨覆盖超过50%,可考虑行植骨加非骨水泥型髋臼假体置换;自体骨覆盖不足50%,宜行骨水泥型髋臼假体置换。如骨缺损面积较大,可行加强环等翻修。从随访中可见,颗粒骨打压植骨是治疗髋臼骨缺损可靠的方法。     

BMP2基因修饰犬脂肪源性基质细胞修复自体大段骨缺损

目的 评价BMP2基因修饰的犬脂肪源性基质细胞(ADSCs)与β-磷酸三钙(β-TCP)复合修复自体大段骨缺损的疗效.方法 从比格犬背部脂肪组织中提取基质细胞,转染腺病毒介导的人BMP2基因(Adv-hBMP2),通过ELISA和裸鼠体内异位成骨实验鉴定BMP2的表达及异位成骨活性;取比格犬11只,制作双侧尺骨2.5 cm骨缺损模型,缺损处旷置(4侧)或随机填充:单纯TCP(6侧),AD-SCs+TCP(6侧),Adv-hBMP2-ADSCs+TCP(6侧).所有动物16周后处死.结果 ELISA显示犬ADSCs被腺病毒转染后可高表达具有成骨活性的BMP2;裸鼠体内异位成骨实验证实所分泌的BMP2具有骨诱导活性.骨缺损修复的X线片显示,单纯TCP和ADSCs+TCP组至16周时,骨缺损均未愈合;BMP2基因修饰ADSCs+TCP组6例中2例愈合,4例部分愈合.显微摄片和组织学观察示:单纯TCP和AD-SCs+TCP组仅在骨缺损断端形成编织骨,缺损中央被纤维组织填充,而Adv-hBMP2-ADSCs+TCP组骨.缺损处皮质连续,新生骨组织主要为编织骨,部分改建形成板层骨.组织形态学分析示BMP2基因修饰ADSCs明显促进了新骨形成.结论 BMP2基因修饰ADSCs可以修复犬尺骨大段骨缺损.     

Evaluation of a porous tantalum uncemented acetabular cup in revision total hip arthroplasty: clinical and radiological results of 60 hips

Long-term survival of the acetabular component in revision total hip arthroplasty (THA) is determined by initial implant stability and bone ingrowth. Highly porous Trabecular Metal (TM, Zimmer, Inc, Warsaw, Ind) facilitates ingrowth and may be an ideal material for revision THA. The outcome and survivorship of a TM, nonmodular, uncemented acetabular cup were assessed in 60 consecutive patients undergoing revision THA (mean follow-up, 42 months; range, 14-68 months). Most (55/60) acetabular cups were implanted without screw fixation. Mean Harris Hips Scores improved from 74.8 preoperatively to 94.4 at last follow-up. Serial radiographs demonstrated excellent bone apposition and bone graft incorporation. Complications were limited to 7 cases of dislocation and 1 revision for aseptic loosening. The TM acetabular cup appears suitable for use in revision THA and warrants further study.     

The Boiled-Egg Technique : A New Method for Obtaining Femoral Head Autograft Used in Acetabular Defect Reconstruction

Primary total hip arthroplasty can be complicated by acetabular bony defects, threatening the biomechanical integrity of the prosthesis. Traditionally, when autologous bone is used to pack these defects, it is obtained from thin slices of femoral head in addition to acetabular reamings. We report a novel technique for the acquisition of autologous femoral head bone graft used in the reconstruction of acetabular defects during primary total hip arthroplasty.     

Significance of primary stabilization of the acetabular part of hip endoprosthesis in revision arthroplasty with extensive bone defects]

In this article author discuss medium term results of first or next secondary replacement of acetabular part of hip endoprosthesis--after filling up cavernous or segmental bone defects. There were analysed 104 operated hips 70 (67.3%) female and 34 (32.7%) male. Bilateral hip arthroplasty (in two sessions) was performed in 14 women and 5 men. The average age was 69.8 years. The mean time between the primary arthroplasty and the revision was 12.1 years. The follow up was 2-15 years, mean 5.4 years. Cemented acetabulum was used in 71 revisions (68.3%), self-threaded in 19 (18.3%) and pressed in 14 (13.5%). Destabilization and migration of acetabular part of prosthesis appeared in 14 events (13.5%). Radiolucency local zones on X-ray referred to possible pseudomembrane round the acetabular part without clinical manifestations were shown in 19 cases (18.3%). The study demonstrated that migration of acetabular part of hip prosthesis due to secondary stabilisation deficiency took place in hips were proper primary stabilisation was not achieved because of extensive bone defects.     

Total hip arthroplasty revision in elderly people with cement and Burch–Schneider anti-protrusio cage

Total hip arthroplasty revision is increasingly becoming a common procedure, but the acetabular bone loss and the advanced age of the patients make revision procedures extremely complex and technically demanding. The aim of the present work is to examine the clinical and radiological results of the Burch–Schneider anti-protrusio cage (APC) implanted in revision hip arthroplasty with severe acetabular bone deficiency in elderly people. Between February 1994 and November 2005, a total of 60 revision operations of acetabular components were performed in 60 select patients (42 females and 18 males), using the Burch–Schneider APC. The indication for the Burch–Schneider APC use was massive pelvic bone loss with migration of the prosthesis cup and high-grade acetabular defects (type III or IV AAOS). The mean age at the time of surgery was 82 years (range 78–85 years). Polymethylmetacrylate cement (PMMA) was used to fill bony deficiencies in all the procedures. No graft was used. The average Harris Hip Score had improved from 28.2 preoperatively to 82.5 points at the time of follow-up. According to the classification of Gill et al., we have seen no Burch–Schneider cages definitely loose or probably. Only one acetabular component has been revised (for recurrent dislocation). Acetabular reconstruction with the use of cement and an acetabular support ring appears to have a useful role in the treatment of severe acetabular bony deficiency in elderly patients and may provide a definitive reconstruction.