Addressing severe bone deficiency: what a cage will not do.

Managing severe acetabular bone loss in total hip arthroplasty revision can be a tremendous challenge. Osteolysis and migration of the acetabular component can lead to large uncontained defects. Traditionally, these deficiencies have been treated with allograft with or without the support of a cage. In severe cases, a majority of the cage support is via allograft instead of host bone. Sometimes, with remodeling and resorption of the allograft, the cage can lose structural support, leading to fatigue and failure. In these situations, trabecular metal has become a viable alternative. Deficiencies of acetabular bone can be independently addressed and reconstructed providing initial stability and, we believe, long-term biologic fixation to host bone.