The utilization of porous metal augments for acetabular reconstruction during revision total hip arthroplasty

Revision total hip arthroplasty continues to increase rapidly, with formidable challenges in managing complex acetabular bone defects. Porous metal augments have emerged as an efficacious solution, offering superior mechanical stability, greater osseointegration potential and better biomechanical reconstruction compared to traditional methods like structural allografts and jumbo cups. These augments can address various defect patterns with configurations tailored to specific defect location and extent (e.g., roofing, flying buttress, column buttress, doming, and footing configurations). Key material advantages include high porosity, optimal pore diameter, good biocompatibility, enhanced coefficient of friction, and native elastic modulus similar to the trabecula. Clinical studies reported 10-year survivorship rates exceeding 90% for severe defects (Paprosky type III), with precise hip centre restoration and reduced complications. The newly introduced rim-point-column-oriented algorithm provides a practical framework for optimised reconstruction using porous metal augments by emphasising rim or 3-point fixation, column stabilisation and medial wall support. Combined strategies, such as acetabular distraction for pelvic discontinuity, further extend indications and improve outcomes. However, concerns persist regarding metal debris release at cup-augment interfaces and the inability to restore bone stock in young patients. Emerging innovations, including 3D-printed porous augments, show comparable efficacy with customised advantages. Porous metal augments represent a versatile and durable option for complex acetabular reconstruction, though lifelong surveillance through follow-up is warranted.