Volume 14, Supplement 1
Original Article / Published: April 2026
DOI: https://www.doi.org/10.57045/jemis/1410426.pp33-34
R. Milev, N. Tzachev, P. Ivanov, P. Ginev, N. Hariskov
Department of orthopaedics, traumatology, reconstructive surgery and physiotherapy, Military Medical Academy, Sofia, Bulgaria
Abstract
Introduction: With the increasing number of Total Hip Arthroplasties (THAs), the significance of revision surgeries has also grown. Acetabular defects are a major concern in hip arthroplasty, especially during revision procedures. One of the classifications used to describe the severity of these defects is the Paprosky classification, which is based on the extent of bone loss and the structural integrity of the acetabulum.
Objective: Paprosky Type 3 defects represent severe bone loss, involving significant erosion of the acetabular rim and loss of both superior and inferior bone stock. Our approach to managing these types of acetabular defects includes custom-made implants and acetabular reconstructions cages. The goal of our treatment is to restore acetabular integrity and provide a stable foundation for the hip prosthesis.
Materials and Methods: We present a retrospective case series of 46 patients (32 female and 14 male, mean age 66 years). All patients underwent CT scan before surgery. The type of defect was assessed according to the Paprosky classification, with all cases being classified as Type 3 defects, caused by either aseptic or septic loosening of the cup. Most of the patients had primary cemented cups (40 patients), with 22 cases due to septic loosening (treated using a two-stage protocol for periprosthetic joint infection). The study period ranged from 2019 to 2025. Our surgical approach included the use of two types of reinforcement acetabular rings with hooks (34 patients) or custom-made implants (12 patients), in all cases with bone allografts.
Results: Following revision surgery, improvements in range of motion and the restoration of normal daily activities were observed. The average Harris Hip Score (HHS) increased to 70-80. Full integration was observed 6 months post-surgery, and leg length discrepancy was restored with an average of 1.5 cm improvement. As a complication, we registered one Periprosthetic joint infection (PJI) in a patient with an acetabular ring, treated according to the two-stage protocol for PJI. Also, we had 2 wound complications in female patients diagnosed with braced cancer and with metabolically inactive pelvic metastasis, requiring several wound revisions, but without affecting the implants.
Conclusion: Although challenging, successful reconstruction of Paprosky Type 3 defects can result in improved clinical outcomes and enhanced patient function.
Keywords:
revision hip arthroplasty, acetabular defects, paprosky type 3, acetabular reconstruction, periprosthetic joint infection (PJI)
How to cite this article:
R. Milev, N. Tzachev, P. Ivanov, P. Ginev, N. Hariskov. Revision THA in Paprosky type 3 acetabular defects. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2026; 14(1): 33-34
Corresponding author:
Dr.Radoslav Milev
Military Medical Academy Sofia, Department of Orthopaedic and Trauma Surgery, 3’’Georgi Sofiiski’’ blvd, Sofia 1606
Email: radoslavem@yahoo.com