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Cementless revision of the acetabulum

An approach is presented to the repair of pelvic defects encountered primarily in the cementless revision of the acetabulum. A classification is presented that not only indicates the position and extent of the defect, but also gives the surgeon a concept of the fixation that will be necessary when bone grafting is attempted. It is also suggested that by reducing defects to a classification such as this, the eventual outcomes and results of repair can be studied more accurately. It is no longer adequate to lump all revisions into one category; the severity and extent of defects need to be taken into account when considering the final outcome. The outcome of stage I and II repairs may be as good as, if not better than, primary repairs; whereas stage III repairs, which require massive bone grafting, present tremendous technical challenges to the surgeon and require substantial allograft in many instances. It is perhaps appropriate that these cases be evaluated as separate entities.