A Review Paper 510 The American Journal of Orthopedics ® Abstract Cemented revision techniques have been used with vari- able success in the reconstruction of the failed ace- tabular component. Diminished cement–bone interlock secondary to diminished cancellous bone quality and quantity may contribute to the observed high rates of aseptic loosening of this construct in the revision setting. Nevertheless, this technique may still be an option in the elderly patient with limited function or life expectancy. Impaction bone grafting in conjunction with cemented acetabular cups has been reported to result in good mid- term results. The reconstruction is challenging and tedious and requires meticulous execution for success. When per- formed well, impaction grafting can result in survivorship rates equaling those seen using cementless hemispheric cups with the additional advantage of increasing acetabu- lar bone stock. C ementing the acetabular component in revision hip surgery has been associated with a high loos- ening rate. Advances in cementing technique have not reduced this problem. Diminished cancellous bone in the acetabular bed and retention of the subchondral plate may contribute to a weaker mechanical interlock and increased stress concentration at the bone–cement inter- face, respectively. Large segmental and cavitary defects have been successfully managed with impacted morselized cancellous bone grafting and a cemented cup. Various aspects of this technique, including graft type, size, and compaction technique, are important for graft incorpora- tion. Acetabular reconstruction using impaction grafting is a technically demanding and exacting procedure that, when performed well, can have a high success rate. Cemented Revisions The results of acetabular revision with a cemented cup have been poor. Callaghan and colleagues 1 reported on 146 ace- tabular revisions performed using a cemented cup at a mean follow-up of 3.6 years. Results were good to excellent in only 66% of the patients. Twenty-nine percent showed progressive radiolucencies, and 9% showed acetabular migration. Definite mechanical failure was noted in 15.8% of hips. Twelve hips (8.6%) were rerevised. Kavanagh and colleagues 2 reported on 166 cemented revision hip arthroplasties followed for a minimum of 2 years. Radiographic evidence of loosening was seen in 20% of acetabular components. Advances in cementing technique have not improved the results of acetabular revision with cement. Katz and colleagues 3 reported on 83 cemented revision hip arthro- plasties in which a plunger system was used to pressurize the acetabular cement. At the minimum follow-up of 10 years, 16% were revised for aseptic acetabular loosening. Thirty-five percent, including the revised cases, had radio- graphic acetabular loosening. Ten-year survivorship of the acetabular component was 72% with definite or probable radiographic evidence of loosening as the endpoint. In the revision setting, the cancellous bony bed of the acetabulum is diminished in quantity and quality, com- pared with the primary arthroplasty setting. After removal of a primary implant, the remaining acetabular bone is often remodeled to a relatively smooth and sclerotic end- osteal surface. 4 Ritter and Thong 5 emphasized that the Reconstruction of the Failed Acetabular Component Using Cemented Shells and Impaction Grafting in Revision Hip Arthroplasty Paul S. Issack, MD, PhD, Burak Beksac, MD, David L. Helfet, MD, Robert L. Buly, MD, and Thomas P. Sculco, MD Dr. Issack is Fellow, Orthopaedic Trauma and Adult Reconstructive Surgery, and Dr. Beksac is Research Fellow, Adult Reconstructive Surgery, Hospital for Special Surgery, New York, New York. Dr. Helfet is Attending Surgeon and Director, Orthopaedic Trauma Service, Hospital for Special Surgery and Weill-Cornell Medical Center, New York, New York. Dr. Buly is Attending Orthopaedic Surgeon, and Dr. Sculco is Surgeon-in-Chief, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. Address correspondence to: Paul S. Issack, MD, PhD, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021 (tel, 212- 606-1466; fax, 212-472-6023; e-mail, psissack@aol.com). Am J Orthop. 2008;37(10):510-512. Copyright Quadrant HealthCom Inc. 2008. All rights reserved. “Advances in cementing technique have not improved the results of acetabular revision with cement.”