Research progress in the Cup-cage reconstruction for patients with chronic pelvic discontinuity after total hip arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

PU Xingxiao , WANG Qiuru , LI Qianhao , CAI Lijun , HAN Guangtao ,  KANG Pengde

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

KANG Pengde, Email: kangpd@163.com

Keywords：

Cup-cage renconstruction; total hip arthroplasty; chronic pelvic discontinuity

DOI：

10.7507/1002-1892.202408064

Video：

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Objective To summarize research progress on application of Cup-cage reconstruction in revision of chronic pelvic discontinuity (CPD) in patients undergoing total hip arthroplasty (THA). Methods Relevant literature at home and abroad in recent years was reviewed to summarize the principles of the Cup-cage reconstruction, preoperative patient assessment, intraoperative skills, clinical and radiological effectiveness, limitations, and postoperative complications.Results For the treatment of CPD, the Cup-cage reconstruction achieved long-term acetabular cup bone ingrowth, CPD healing, and biologic fixation of the prosthesis by restoring pelvic continuity. Preoperative evaluation of the surgical site and general condition is necessary. The main intraoperative objectives are to reconstruct pelvic continuity, restore the center of rotation of the hip, and avoid neurovascular injury. Current studies have demonstrated significant clinical and radiological effectiveness as well as acceptable prosthesis survival rates after operation. Nevertheless, there is a lack of evidence regarding the staging of CPD, the optimal surgical approach and internal fixation, and the factors influencing postoperative prosthesis survival remain undefined. Conclusion Cup-cage reconstruction can be an effective treatment for CPD after THA, but there is still a need to explore CPD staging, Cup-cage approach and internal fixation, and influencing factors on prosthesis survival.

1.	DeBoer DK, Christie MJ, Brinson MF, et al. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg (Am), 2007, 89(4): 835-840.
2.	康鹏德, 裴福兴. 髋关节翻修中骨盆不连续的评估与重建. 中华骨科杂志, 2020, 40(9): 614-624.
3.	Babis GC, Nikolaou VS. Pelvic discontinuity: a challenge to overcome. EFORT Open Rev, 2021, 6(6): 459-471.
4.	Hipfl C, Perka C. Intraoperative acetabular fracture. Z Orthop Unfall, 2024, 162(3): 303-309.
5.	Rogers BA, Whittingham-Jones PM, Mitchell PA, et al. The reconstruction of periprosthetic pelvic discontinuity. J Arthroplasty, 2012, 27(8): 1499-1506.
6.	Sanghavi SA, Paprosky WG, Sheth NP. Evaluation and management of acetabular bone loss in revision total hip arthroplasty: a 10-year update. J Am Acad Orthop Surg, 2024, 32(10): e466-e475.
7.	Tarabichi S, Baker CM, Lizcano JD, et al. Porous metal augments have comparable outcomes to other constructs for severe acetabular bone loss at mid-term follow-up. J Arthroplasty, 2024. doi: 10.1016/j.arth.2024.05.089.
8.	Chaudhry F, Daud A, Greenberg A, et al. Cup-cage constructs in revision total hip arthroplasty for pelvic discontinuity. Bone Joint J, 2024, 106-B(5 Supple B): 66-73.
9.	Hipfl C, Janz V, Löchel J, et al. Cup-cage reconstruction for severe acetabular bone loss and pelvic discontinuity: Mid-term results of a consecutive series of 35 cases. Bone Joint J, 2018, 100-B(11): 1442-1448.
10.	Callary SA, Broekhuis D, Barends J, et al. Virtual biomechanical assessment of porous tantalum and custom triflange components in the treatment of patients with acetabular defects and pelvic discontinuity. Bone Joint J, 2024, 106-B(5 Supple B): 74-81.
11.	Mu W, Xu B, Wahafu T, et al. What are the functional, radiographic, and survivorship outcomes of a modified cup-cage technique for pelvic discontinuity? Clin Orthop Relat Res, 2024. doi: 10.1097/CORR.0000000000003186.
12.	Wang CX, Huang ZD, Wu BJ, et al. Cup-cage solution for massive acetabular defects: a systematic review and meta-analysis. Orthop Surg, 2020, 12(3): 701-707.
13.	Chen CJ, Zhao X, Mohammed A, et al. Survivorship and clinical outcomes of ‘cup-cage’ reconstruction in revision of hip arthroplasty for chronic pelvic discontinuity: A systematic review. Surgeon, 2021, 19(6): e475-e484.
14.	Chang CY, Wu CT, Numan H, et al. Survival analysis of allografting and antiprotrusio cage in treating massive acetabular bone defects. J Arthroplasty, 2021, 36(2): 682-687.
15.	Hanssen AD, Lewallen DG. Modular acetabular augments: composite void fillers. Orthopedics, 2005, 28(9): 971-972.
16.	Jara-García F, Diranzo-García J, Estrems-Díaz V, et al. Trabecular titanium implants in complex acetabular revision surgery. Rev Esp Cir Ortop Traumatol, 2023, 67(2): 94-101.
17.	薛昭曦, 伊力夏提·麦麦提艾麦提, 郭文涛, 等. 钽金属骨小梁髋臼系统重建假体周围感染髋臼缺损的临床效果. 中华外科杂志, 2024, 62(9): 847-855.
18.	王聪聪, 孙水. 严重髋臼骨缺损治疗技术的应用进展. 山东医药, 2018, 58(39): 104-106.
19.	Abolghasemian M, Tangsaraporn S, Drexler M, et al. The challenge of pelvic discontinuity: cup-cage reconstruction does better than conventional cages in mid-term. Bone Joint J, 2014, 96-B(2): 195-200.
20.	Malahias MA, Ma QL, Gu A, et al. Outcomes of acetabular reconstructions for the management of chronic pelvic discontinuity: a systematic review. J Arthroplasty, 2020, 35(4): 1145-1153.
21.	穆文博, 胥伯勇, 郭文涛, 等. 应用cup-cage技术重建Paprosky ⅢB型髋臼骨缺损的早期疗效. 中华骨科杂志, 2017, 37(7): 393-400.
22.	Sheth NP, Jones SA, Sanghavi SA, et al. How modular porous metal augments have changed the management of acetabular bone loss at primary or revision total hip arthroplasty. Bone Joint J, 2024, 106-B(4): 312-318.
23.	Wassilew GI, Zimmerer A, Fischer M, et al. Reconstruction of Paprosky ⅢB acetabular defects with porous tantalum shells and augments using the footing technique. Bone Joint J, 2024, 106-B(5 Supple B): 54-58.
24.	Assi C, Mansour J, Boulos K, et al. Major acetabular defects: outcomes of first revision total hip arthroplasty using Kerboull cross-plate with allograft and cemented dual mobility cup at a maximum follow-up of fourteen years. Int Orthop, 2022, 46(11): 2539-2546.
25.	Martin JR, Barrett IJ, Sierra RJ, et al. Preoperative radiographic evaluation of patients with pelvic discontinuity. J Arthroplasty, 2016, 31(5): 1053-1056.
26.	Kerbel YE, Pirruccio K, Shirley Z, et al. Superior pubic ramus screw placement during complex acetabular revision: acetabular distraction for treatment of pelvic discontinuity. JBJS Essent Surg Tech, 2022, 12(3): e21.00014. doi: 10.2106/JBJS.ST.21.00014.
27.	Garceau SP, Warschawski Y, Joly D, et al. Hip arthroplasty with the use of a reconstruction cage and porous metal augment to treat massive acetabular bone loss: a midterm follow-up. J Arthroplasty, 2022, 37(7S): S636-S641.
28.	Meynen A, Vles G, Roussot M, et al. Advanced quantitative 3D imaging improves the reliability of the classification of acetabular defects. Arch Orthop Trauma Surg, 2023, 143(3): 1611-1617.
29.	Sculco PK, Wright T, Malahias MA, et al. The diagnosis and treatment of acetabular bone loss in revision hip arthroplasty: an international consensus symposium. HSS J, 2022, 18(1): 8-41.
30.	Siddiqi A, Alden KJ, Yerasimides JG, et al. Direct anterior approach for revision total hip arthroplasty: anatomy and surgical technique. J Am Acad Orthop Surg, 2021, 29(5): e217-e231.
31.	Lancaster A, Treu E, Gililland J, et al. Direct anterior cup-half cage for revision and complex primary total hip arthroplasty: surgical technique. Arthroplast Today, 2022, 16: 140-149.
32.	Gupta VK, Hoskins WT, Frampton CMA, et al. No difference in revision rates or patient-reported outcome measures between surgical approaches for total hip arthroplasty performed for femoral neck fracture: an analysis of 5,025 primary total hip arthroplasties from the New Zealand joint registry. J Arthroplasty, 2024, 39(11): 2767-2773.
33.	Gentry W, Stambough JB, Porter A, et al. Surgical approach does not affect chronic opioid usage after total hip arthroplasty. J Arthroplasty, 2023, 38(9): 1812-1816.
34.	Rhee I, Tirosh O, Ho A, et al. Do certain patient cohorts benefit from different surgical approaches in total hip arthroplasty? J Arthroplasty, 2023, 38(8): 1545-1550.
35.	Yan L, Ge L, Dong S, et al. Evaluation of comparative efficacy and safety of surgical approaches for total hip arthroplasty: a systematic review and network meta-analysis. JAMA Netw Open, 2023, 6(1): e2253942. doi: 10.1001/jamanetworkopen.2022.53942.
36.	石小军, 赵海燕, 热勒肯·叶尔生, 等. 不同手术入路全髋关节置换术后并发症对比: 单中心大样本回顾性病例对照研究. 中华骨与关节外科杂志, 2020, 13(11): 898-904. doi: 10.3969/j.issn.2095-9958.2020.11.04.
37.	Xu LW, Veeravagu A, Azad TD, et al. Delayed presentation of sciatic nerve injury after total hip arthroplasty: neurosurgical considerations, diagnosis, and management. J Neurol Surg Rep, 2016, 77(3): e134-e138.
38.	Blackburn AZ, Mittal A, Velasco B, et al. AAHKS Surgical Techniques & Technologies Award: Inferior screw fixation decreases acetabular component failure following revision total hip arthroplasty. J Arthroplasty, 2024, 39(9S2): S8-S12.
39.	Osoba MY, Rao AK, Agrawal SK, et al. Balance and gait in the elderly: A contemporary review. Laryngoscope Investig Otolaryngol, 2019, 4(1): 143-153.
40.	Waibel FWA, Berndt K, Jentzsch T, et al. Symptomatic leg length discrepancy after total hip arthroplasty is associated with new onset of lower back pain. Orthop Traumatol Surg Res, 2021, 107(1): 102761. doi: 10.1016/j.otsr.2020.102761.
41.	Martin JR, Barrett I, Sierra RJ, et al. Construct rigidity: Keystone for treating pelvic discontinuity. J Bone Joint Surg (Am), 2017, 99(9): e43. doi: 10.2106/JBJS.16.00601.
42.	Kobayashi K, Tsurumoto N, Tsuda S, et al. The anterior position of the hip center of rotation is related to anterior cup protrusion length and symptomatic iliopsoas impingement in primary total hip arthroplasty. J Arthroplasty, 2023, 38(11): 2366-2372.
43.	田最, 高振中, 尹志文, 等. 全髋关节置换术中髋关节旋转中心重建方法的研究进展. 中华解剖与临床杂志, 2022, 27(6): 438-443.
44.	Vanrusselt J, Vansevenant M, Vanderschueren G, et al. Postoperative radiograph of the hip arthroplasty: what the radiologist should know. Insights Imaging, 2015, 6(6): 591-600.
45.	Shi HF, Xiong J, Chen YX, et al. Radiographic analysis of the restoration of hip joint center following open reduction and internal fixation of acetabular fractures: a retrospective cohort study. BMC Musculoskelet Disord, 2014, 15: 277. doi: 10.1186/1471-2474-15-277.
46.	Sculco PK, Ledford CK, Hanssen AD, et al. The evolution of the cup-cage technique for major acetabular defects: full and half cup-cage reconstruction. J Bone Joint Surg (Am), 2017, 99(13): 1104-1110.
47.	Pegios VF, Kenanidis E, Tsotsolis S, et al. Bisphosphonates’ use and risk of aseptic loosening following total hip arthroplasty: a systematic review. EFORT Open Rev, 2023, 8(11): 798-808.
48.	Layson JT, Hameed D, Dubin JA, et al. Patients with osteoporosis are at higher risk for periprosthetic femoral fractures and aseptic loosening following total hip arthroplasty. Orthop Clin North Am, 2024, 55(3): 311-321.
49.	Prock-Gibbs H, Pumilia CA, Meckmongkol T, et al. Incidence of osteolysis and aseptic loosening following metal-on-highly cross-linked polyethylene hip arthroplasty: A systematic review of studies with up to 15-year follow-up. J Bone Joint Surg (Am), 2021, 103(8): 728-740.
50.	Hitz O, Le Baron M, Jacquet C, et al. Use of dual mobility cup cemented into a tantalum acetabular shell for hip revision with large bone loss can decrease dislocation risk without increasing the risk of mechanical failure. Orthop Traumatol Surg Res, 2024, 110(2): 103739. doi: 10.1016/j.otsr.2023.103739.
51.	Ballester Alfaro JJ, Sueiro Fernández J. Trabecular metal buttress augment and the trabecular metal cup-cage construct in revision hip arthroplasty for severe acetabular bone loss and pelvic discontinuity. Hip Int, 2010, 20 Suppl 7: S119-S127.
52.	Amenabar T, Rahman WA, Hetaimish BM, et al. Promising mid-term results with a cup-cage construct for large acetabular defects and pelvic discontinuity. Clin Orthop Relat Res, 2016, 474(2): 408-414.
53.	Kosashvili Y, Backstein D, Safir O, et al. Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. J Bone Joint Surg (Br), 2009, 91(7): 870-876.
54.	Konan S, Duncan CP, Masri BA, et al. The cup-cage reconstruction for pelvic discontinuity has encouraging patient satisfaction and functional outcome at median 6-year follow-up. Hip Int, 2017, 27(5): 509-513.
55.	Arvinte D, Kiran M, Sood M. Cup-cage construct for massive acetabular defect in revision hip arthroplasty—A case series with medium to long-term follow-up. J Clin Orthop Trauma, 2020, 11(1): 62-66.

1. DeBoer DK, Christie MJ, Brinson MF, et al. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg (Am), 2007, 89(4): 835-840.
2. 康鹏德, 裴福兴. 髋关节翻修中骨盆不连续的评估与重建. 中华骨科杂志, 2020, 40(9): 614-624.
3. Babis GC, Nikolaou VS. Pelvic discontinuity: a challenge to overcome. EFORT Open Rev, 2021, 6(6): 459-471.
4. Hipfl C, Perka C. Intraoperative acetabular fracture. Z Orthop Unfall, 2024, 162(3): 303-309.
5. Rogers BA, Whittingham-Jones PM, Mitchell PA, et al. The reconstruction of periprosthetic pelvic discontinuity. J Arthroplasty, 2012, 27(8): 1499-1506.
6. Sanghavi SA, Paprosky WG, Sheth NP. Evaluation and management of acetabular bone loss in revision total hip arthroplasty: a 10-year update. J Am Acad Orthop Surg, 2024, 32(10): e466-e475.
7. Tarabichi S, Baker CM, Lizcano JD, et al. Porous metal augments have comparable outcomes to other constructs for severe acetabular bone loss at mid-term follow-up. J Arthroplasty, 2024. doi: 10.1016/j.arth.2024.05.089.
8. Chaudhry F, Daud A, Greenberg A, et al. Cup-cage constructs in revision total hip arthroplasty for pelvic discontinuity. Bone Joint J, 2024, 106-B(5 Supple B): 66-73.
9. Hipfl C, Janz V, Löchel J, et al. Cup-cage reconstruction for severe acetabular bone loss and pelvic discontinuity: Mid-term results of a consecutive series of 35 cases. Bone Joint J, 2018, 100-B(11): 1442-1448.
10. Callary SA, Broekhuis D, Barends J, et al. Virtual biomechanical assessment of porous tantalum and custom triflange components in the treatment of patients with acetabular defects and pelvic discontinuity. Bone Joint J, 2024, 106-B(5 Supple B): 74-81.
11. Mu W, Xu B, Wahafu T, et al. What are the functional, radiographic, and survivorship outcomes of a modified cup-cage technique for pelvic discontinuity? Clin Orthop Relat Res, 2024. doi: 10.1097/CORR.0000000000003186.
12. Wang CX, Huang ZD, Wu BJ, et al. Cup-cage solution for massive acetabular defects: a systematic review and meta-analysis. Orthop Surg, 2020, 12(3): 701-707.
13. Chen CJ, Zhao X, Mohammed A, et al. Survivorship and clinical outcomes of ‘cup-cage’ reconstruction in revision of hip arthroplasty for chronic pelvic discontinuity: A systematic review. Surgeon, 2021, 19(6): e475-e484.
14. Chang CY, Wu CT, Numan H, et al. Survival analysis of allografting and antiprotrusio cage in treating massive acetabular bone defects. J Arthroplasty, 2021, 36(2): 682-687.
15. Hanssen AD, Lewallen DG. Modular acetabular augments: composite void fillers. Orthopedics, 2005, 28(9): 971-972.
16. Jara-García F, Diranzo-García J, Estrems-Díaz V, et al. Trabecular titanium implants in complex acetabular revision surgery. Rev Esp Cir Ortop Traumatol, 2023, 67(2): 94-101.
17. 薛昭曦, 伊力夏提·麦麦提艾麦提, 郭文涛, 等. 钽金属骨小梁髋臼系统重建假体周围感染髋臼缺损的临床效果. 中华外科杂志, 2024, 62(9): 847-855.
18. 王聪聪, 孙水. 严重髋臼骨缺损治疗技术的应用进展. 山东医药, 2018, 58(39): 104-106.
19. Abolghasemian M, Tangsaraporn S, Drexler M, et al. The challenge of pelvic discontinuity: cup-cage reconstruction does better than conventional cages in mid-term. Bone Joint J, 2014, 96-B(2): 195-200.
20. Malahias MA, Ma QL, Gu A, et al. Outcomes of acetabular reconstructions for the management of chronic pelvic discontinuity: a systematic review. J Arthroplasty, 2020, 35(4): 1145-1153.
21. 穆文博, 胥伯勇, 郭文涛, 等. 应用cup-cage技术重建Paprosky ⅢB型髋臼骨缺损的早期疗效. 中华骨科杂志, 2017, 37(7): 393-400.
22. Sheth NP, Jones SA, Sanghavi SA, et al. How modular porous metal augments have changed the management of acetabular bone loss at primary or revision total hip arthroplasty. Bone Joint J, 2024, 106-B(4): 312-318.
23. Wassilew GI, Zimmerer A, Fischer M, et al. Reconstruction of Paprosky ⅢB acetabular defects with porous tantalum shells and augments using the footing technique. Bone Joint J, 2024, 106-B(5 Supple B): 54-58.
24. Assi C, Mansour J, Boulos K, et al. Major acetabular defects: outcomes of first revision total hip arthroplasty using Kerboull cross-plate with allograft and cemented dual mobility cup at a maximum follow-up of fourteen years. Int Orthop, 2022, 46(11): 2539-2546.
25. Martin JR, Barrett IJ, Sierra RJ, et al. Preoperative radiographic evaluation of patients with pelvic discontinuity. J Arthroplasty, 2016, 31(5): 1053-1056.
26. Kerbel YE, Pirruccio K, Shirley Z, et al. Superior pubic ramus screw placement during complex acetabular revision: acetabular distraction for treatment of pelvic discontinuity. JBJS Essent Surg Tech, 2022, 12(3): e21.00014. doi: 10.2106/JBJS.ST.21.00014.
27. Garceau SP, Warschawski Y, Joly D, et al. Hip arthroplasty with the use of a reconstruction cage and porous metal augment to treat massive acetabular bone loss: a midterm follow-up. J Arthroplasty, 2022, 37(7S): S636-S641.
28. Meynen A, Vles G, Roussot M, et al. Advanced quantitative 3D imaging improves the reliability of the classification of acetabular defects. Arch Orthop Trauma Surg, 2023, 143(3): 1611-1617.
29. Sculco PK, Wright T, Malahias MA, et al. The diagnosis and treatment of acetabular bone loss in revision hip arthroplasty: an international consensus symposium. HSS J, 2022, 18(1): 8-41.
30. Siddiqi A, Alden KJ, Yerasimides JG, et al. Direct anterior approach for revision total hip arthroplasty: anatomy and surgical technique. J Am Acad Orthop Surg, 2021, 29(5): e217-e231.
31. Lancaster A, Treu E, Gililland J, et al. Direct anterior cup-half cage for revision and complex primary total hip arthroplasty: surgical technique. Arthroplast Today, 2022, 16: 140-149.
32. Gupta VK, Hoskins WT, Frampton CMA, et al. No difference in revision rates or patient-reported outcome measures between surgical approaches for total hip arthroplasty performed for femoral neck fracture: an analysis of 5,025 primary total hip arthroplasties from the New Zealand joint registry. J Arthroplasty, 2024, 39(11): 2767-2773.
33. Gentry W, Stambough JB, Porter A, et al. Surgical approach does not affect chronic opioid usage after total hip arthroplasty. J Arthroplasty, 2023, 38(9): 1812-1816.
34. Rhee I, Tirosh O, Ho A, et al. Do certain patient cohorts benefit from different surgical approaches in total hip arthroplasty? J Arthroplasty, 2023, 38(8): 1545-1550.
35. Yan L, Ge L, Dong S, et al. Evaluation of comparative efficacy and safety of surgical approaches for total hip arthroplasty: a systematic review and network meta-analysis. JAMA Netw Open, 2023, 6(1): e2253942. doi: 10.1001/jamanetworkopen.2022.53942.
36. 石小军, 赵海燕, 热勒肯·叶尔生, 等. 不同手术入路全髋关节置换术后并发症对比: 单中心大样本回顾性病例对照研究. 中华骨与关节外科杂志, 2020, 13(11): 898-904. doi: 10.3969/j.issn.2095-9958.2020.11.04.
37. Xu LW, Veeravagu A, Azad TD, et al. Delayed presentation of sciatic nerve injury after total hip arthroplasty: neurosurgical considerations, diagnosis, and management. J Neurol Surg Rep, 2016, 77(3): e134-e138.
38. Blackburn AZ, Mittal A, Velasco B, et al. AAHKS Surgical Techniques & Technologies Award: Inferior screw fixation decreases acetabular component failure following revision total hip arthroplasty. J Arthroplasty, 2024, 39(9S2): S8-S12.
39. Osoba MY, Rao AK, Agrawal SK, et al. Balance and gait in the elderly: A contemporary review. Laryngoscope Investig Otolaryngol, 2019, 4(1): 143-153.
40. Waibel FWA, Berndt K, Jentzsch T, et al. Symptomatic leg length discrepancy after total hip arthroplasty is associated with new onset of lower back pain. Orthop Traumatol Surg Res, 2021, 107(1): 102761. doi: 10.1016/j.otsr.2020.102761.
41. Martin JR, Barrett I, Sierra RJ, et al. Construct rigidity: Keystone for treating pelvic discontinuity. J Bone Joint Surg (Am), 2017, 99(9): e43. doi: 10.2106/JBJS.16.00601.
42. Kobayashi K, Tsurumoto N, Tsuda S, et al. The anterior position of the hip center of rotation is related to anterior cup protrusion length and symptomatic iliopsoas impingement in primary total hip arthroplasty. J Arthroplasty, 2023, 38(11): 2366-2372.
43. 田最, 高振中, 尹志文, 等. 全髋关节置换术中髋关节旋转中心重建方法的研究进展. 中华解剖与临床杂志, 2022, 27(6): 438-443.
44. Vanrusselt J, Vansevenant M, Vanderschueren G, et al. Postoperative radiograph of the hip arthroplasty: what the radiologist should know. Insights Imaging, 2015, 6(6): 591-600.
45. Shi HF, Xiong J, Chen YX, et al. Radiographic analysis of the restoration of hip joint center following open reduction and internal fixation of acetabular fractures: a retrospective cohort study. BMC Musculoskelet Disord, 2014, 15: 277. doi: 10.1186/1471-2474-15-277.
46. Sculco PK, Ledford CK, Hanssen AD, et al. The evolution of the cup-cage technique for major acetabular defects: full and half cup-cage reconstruction. J Bone Joint Surg (Am), 2017, 99(13): 1104-1110.
47. Pegios VF, Kenanidis E, Tsotsolis S, et al. Bisphosphonates’ use and risk of aseptic loosening following total hip arthroplasty: a systematic review. EFORT Open Rev, 2023, 8(11): 798-808.
48. Layson JT, Hameed D, Dubin JA, et al. Patients with osteoporosis are at higher risk for periprosthetic femoral fractures and aseptic loosening following total hip arthroplasty. Orthop Clin North Am, 2024, 55(3): 311-321.
49. Prock-Gibbs H, Pumilia CA, Meckmongkol T, et al. Incidence of osteolysis and aseptic loosening following metal-on-highly cross-linked polyethylene hip arthroplasty: A systematic review of studies with up to 15-year follow-up. J Bone Joint Surg (Am), 2021, 103(8): 728-740.
50. Hitz O, Le Baron M, Jacquet C, et al. Use of dual mobility cup cemented into a tantalum acetabular shell for hip revision with large bone loss can decrease dislocation risk without increasing the risk of mechanical failure. Orthop Traumatol Surg Res, 2024, 110(2): 103739. doi: 10.1016/j.otsr.2023.103739.
51. Ballester Alfaro JJ, Sueiro Fernández J. Trabecular metal buttress augment and the trabecular metal cup-cage construct in revision hip arthroplasty for severe acetabular bone loss and pelvic discontinuity. Hip Int, 2010, 20 Suppl 7: S119-S127.
52. Amenabar T, Rahman WA, Hetaimish BM, et al. Promising mid-term results with a cup-cage construct for large acetabular defects and pelvic discontinuity. Clin Orthop Relat Res, 2016, 474(2): 408-414.
53. Kosashvili Y, Backstein D, Safir O, et al. Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. J Bone Joint Surg (Br), 2009, 91(7): 870-876.
54. Konan S, Duncan CP, Masri BA, et al. The cup-cage reconstruction for pelvic discontinuity has encouraging patient satisfaction and functional outcome at median 6-year follow-up. Hip Int, 2017, 27(5): 509-513.
55. Arvinte D, Kiran M, Sood M. Cup-cage construct for massive acetabular defect in revision hip arthroplasty—A case series with medium to long-term follow-up. J Clin Orthop Trauma, 2020, 11(1): 62-66.

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Latest ArticlesResearch progress in the Cup-cage reconstruction for patients with chronic pelvic discontinuity after total hip arthroplasty

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