Tantalum Augments Combined with Antiprotrusio Cages for Massive Acetabular Defects in Revision Arthroplasty

Background: Tantalum components have gained popularity for the management of Paprosky type IIIA and IIIB defects during revision total hip arthroplasty. Although the use of antiprotrusio cages solely shows suboptimal results, there are certain defects that still require their use. We hypothesized that combining tantalum augments and an antiprotrusio cage would (1) improve radiographic stability, (2) enhance survivorship, (3) decrease complications, and (4) improve clinical outcomes. Methods: We retrospectively reviewed 20 patients with Paprosky type IIIA or IIIB defects who underwent revision of the acetabular component with a highly porous tantalum augment and an antiprotrusio cage combination. Preoperative and postoperative radiographs, survivorship free from aseptic component revision, and the Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, and Short Form-36 scores were analyzed. The mean follow-up was 2.8 years. Results: At the most recent follow-up, no antiprotrusio cages had migrated and all tantalum augments had radiographic evidence of osseointegration. In addition, only 2 components were revised for aseptic etiologies and only 1 was loose. Both were revised secondary to failures of the inferior flange of the antiprotrusio cage. All clinical outcome scores significantly improved postoperatively. Finally, the risk of major postoperative complications was noted to be 10%. Conclusions: In summary, a tantalum augment combined with an antiprotrusio cage in Paprosky IIIA and IIIB defects with divergent anatomy not amenable to a hemispherical socket provides a reliable technique to restore the anatomic hip center and prevent superior migration and provides a bony ingrowth surface. Longer term follow-up is required before the technique is widely adapted. Level of Evidence: Level IV, therapeutic studies.