Aims Severe protrusio acetabular defects pose a major technical challenge in revision total hip arthroplasty (THA), and the current literature provides limited evidence regarding optimal reconstruction strategies. The aim of this study was to report the mid-term outcomes of the multicup reconstruction technique for managing the challenging cases. Methods This retrospective cohort study included 40 patients (22 male, 18 female) who underwent revision THA using the multicup reconstruction for severe protrusion defects between 2015 and 2024. A trabecular metal revision shell was implanted medially as a super-augment to support the superior medial acetabular structure. One or two porous hemispherical cups were then cemented either into or onto the shell. The mean follow-up was 61 months (19–119 months). The survival rate of the implants was evaluated by Kaplan-Meier analyses. The functional outcomes were evaluated in terms of the Harris Hip Score (HSS). Results A total of 36 severe protrusio acetabular defects were reconstructed using two porous cups, and four defects were reconstructed using three porous cups. At the most recent follow-up, one patient underwent acetabular revision due to postoperative dislocation, and another developed loosening of the acetabular construct secondary to infection, resulting in a five-year survivorship free from acetabular failure of 94.6% (95% CI 80.0%–98.6%). One patient underwent femoral stem revision three months postoperatively due to a periprosthetic fracture, and another experienced a dislocation at 19 months that was managed with closed reduction. The five-year revision-free survivorship was 92.1% (95% CI 77.4% to 97.4%). Twenty-four patients received cup-in-cup reconstruction, while the other 16 underwent the cup-on-cup approach. The average HHS was improved to 78.0 points (66.5–86.7 points) at the most assessment. Conclusions The reconstruction of severe protrusio acetabular defects using the multicup reconstruction technique demonstrated excellent mid-term outcomes. It represents a reliable option for the management of these challenging defects.
Ji et al. (Thu,) studied this question.