The pedestal cup for the treatment of acetabular revision.

Purpose: An extreme extent of acetabular bone loss makes a primary stable c up fixation very difficult to achieve. No reliable operation method is as y et available. Defect filling with bone cement or bone grafts gives a high l ong-term failure rate. Further revisions are programmed. Methods: The titan ium pedestal cup possibly offers a solution to these situations. It is fixe d in the load-carrying upper vital part of the pelvis. A guide is necessary for this step. The tapered pedestal is reinforced by two large wings for r otational and structural stability. The physiological load transfer goes en tirely through the pedestal. Thus, the cup serves only for articulation, so metimes without any contact to bone. Stuctural bone grafts are not implante d. Due to its modular length the pedestal very often allows a cup position at the original center of rotation. Results: A total of 139 pedestal cups h ave been implanted. Within a prospective study 51 hip revisions have been f ollowed over 1-5 years. The indications include acetabular defects and rese ction arthroplasty. Implant related complications were few and consisted of a first generation screw failure and malpositioning of the pedestal. Clini cal Relevance: After complete removal of all granulomatous tissue and resto ration of physiological joint forces we observed early and spontaneous bone regeneration. Conclusion: We doubt that a bony reconstruction exclusively happens after massive bone grafting. The acetabulum can recover even in cat astrophic cases of pelvic discontinuity without allografts. Nearly all revi sion cases and rim defects can be managed with the pedestal cup.