Outcome of Large-Diameter Jumbo Cups or Acetabular Mesh with Impaction Bone Grafting for Acetabular Defects in Primary and Revision Total Hip Arthroplasty: A Case Series.

INTRODUCTION

Acetabular bone loss remains a formidable challenge in both primary and revision total hip arthroplasty (THA). Large-diameter "jumbo" acetabular cups and acetabular metal mesh with impaction bone grafting are two reconstructive strategies employed to address moderate-to-severe acetabular defects. This case series reports outcomes in four young male patients with Paprosky Type 2B, 2C, and 3A defects managed at a tertiary referral center in India, highlighting the clinical and radiological results of these techniques.

MATERIALS AND

METHODS

Four male patients (age range 29-39 years) presented with acetabular bone deficiency secondary to post-traumatic arthritis, neglected central fracture-dislocation, failed internal fixation, or aseptic loosening of prior cemented THA. Cases were classified using the Paprosky system. Procedures included revision THA with acetabular mesh cage and autogenous iliac crest impaction bone grafting (n = 1), primary THA with jumbo cementless acetabular cups (n = 2), and revision THA with impaction cancellous bone grafting (n = 1). Intraoperative C-arm fluoroscopy was used for cup alignment verification. Outcome assessment included Harris Hip Score (HHS), serial radiographs, and functional walking assessment at 3 months and 1 year.

CONCLUSION

All four patients achieved satisfactory functional recovery with improved pain relief and independent ambulation. No implant loosening, migration, infection, or early revision was observed at follow-up. Jumbo acetabular cups and acetabular mesh with impaction bone grafting represent reliable, technically feasible alternatives to complex three-dimensional cage reconstructions, delivering stable biological fixation in young patients with post-traumatic acetabular deficiency. Meticulous pre-operative planning with radiography and three-dimensional computed tomography, intraoperative decision-making, and structured rehabilitation are essential determinants of success.