Acetabular revision arthroplasty with a novel cementless augment-and-modular-cage system (MRS-C) : Surgical technique and preliminary clinical results

OBJECTIVEOptimal reconstruction of acetabular anatomy and primarily stable bridging even of large bone defects in hip revision surgery by intraoperative cementless application of highly modular components of the MRS-TITAN Comfort (MRS-C) system according to the augment-and-modular-cage principle. INDICATIONSAcetabular defect situations in hip revision surgery, hereditary/acquired acetabular deformities, severe secondary hip osteoarthritis. CONTRAINDICATIONSExtended periacetabular defects of the dorsal pillar, pelvic discontinuities, persisting posttraumatic or periprosthetic infections, lack of intraoperative bony anchorage options. SURGICAL TECHNIQUEConventional positioning. Flexible selection of approach (posterolateral, anterolateral or transgluteal) to the hip joint, if possible using a previous approach. Implant removal, preparation and intraoperative acetabular defect evaluation. Optional impaction bone grafting for biological downsizing. Selection of modular components and augments depending on the defect. Preparation of the obturator foramen for anchorage of the caudal flange. Optional preparation of the os ilium for additional fixation of the cage with flanges. Fixation with polyaxial screws and selection of version/inclination of the cup component. Selection of the inlay (polyethylene/ceramic). POSTOPERATIVE MANAGEMENTPartial weight-bearing with 20 kg body-weight for 6 weeks with crutches. Prophylaxis for deep vein thrombosis and heterotopic ossification. Additional adapted antibiotic therapy in cases of infection. RESULTSA minimum 1‑year follow-up of 42 patients showed significant improvements of Harris Hip Scores (p