The Kerboull cross-plate: from the birth of a concept to the current indications

PURPOSE: Reconstruction of major acetabular bone loss remains a demanding challenge during revision total hip arthroplasty. Since its original description, the Kerboull acetabular reinforcement device, also known as the Kerboull cross-plate or cage, has been developed to restore the native hip centre of rotation, to protect bone graft from early mechanical overload, and to allow cementation of a conventional full-polyethylene or a dual mobility cup. METHODS: This narrative review traces the evolution of the Kerboull cross-plate from its original conception to its current indications. RESULTS: We describe the biomechanical rationale of the device, supported by finite-element analyses demonstrating a marked load-sharing effect that protects the underlying bone graft in comparison with other reinforcement devices or unprotected cemented cups. We detail the surgical technique, as originally reported by Kerboull and Hamadouche, together with subsequent refinements aimed at standardising plate positioning. The principles governing graft selection are discussed: segmental structural defects require a structural graft, whereas morselised graft should be reserved for the filling of contained cavitary defects. The biological and mechanical quality of the graft is dependent on its processing, cryopreserved femoral head allograft being preferable to gamma-irradiated allograft. Finally, we review the mid- to long-term outcomes reported with the Kerboull cross-plate, including the more recent trend towards cementing a dual mobility cup within the device to reduce the risk of instability, and we outline the current indications of this technique of reconstruction. CONCLUSION: The Kerboull cross-plate retains its place as a reliable and time-tested option within the modern armamentarium for severe acetabular bone loss reconstruction.