Introduction. Rings and cages are indicated for use in revision total hip with severe bone loss. Material and Methods. A retrospective study was performed on 37 acetabular revision cases with an average age at revision of 67.8 years. According to Paprosky classification, 54% grade II and 46% grade III. We used two types of cages, Protrusio and Contour cage. We used 23 standard liners and 14 dual mobility cups. Results. The average follow-up was 5.4 years. The mean Merlé-d’Aubigné score improved from 5.48 to 10.5 points (). There were 10 nerve palsies, 6 rings that lost fixation, 10 dislocations, and 4 infections. The need for reoperation for any reason rose to 32% (12/37). Success, defined as a stable reconstruction, was 73%. We found that, using a dual mobility cup cemented into the cage, the dislocation rate and revision rate came down (). Conclusions. The treatment of severe acetabular defects using bone graft and reconstruction cages is a viable option. The use of a dual mobility cup cemented into the cage could avoid dislocations and the insertion of the ischial flap inside the ischial portion of the acetabulum for further ring stability and protection of the sciatic nerve. 1. Introduction The demand for primary total hip arthroplasty (THA) is expected to increase over the next several decades, due to the aging population and the obesity crisis [1]. The need for THA is expected to grow 174% to 572,000 primary THAs per year by 2030 in the United States [1]. Consequently, the demand for revision total hip arthroplasty will also increase exponentially. It is estimated that total hip arthroplasty revisions will double every 10 years [2]. The most common indications for acetabular revision include hip instability, aseptic loosening, periprosthetic osteolysis, and infection [2, 3], with the acetabular component involved in >50% of revisions [3]. Acetabular bone loss can be found in any of the revisions of THA and is one of the factors to be taken into account when determining treatment. There are multiple options for the treatment of these defects, each of which have their strengths and weaknesses, as all have common goals such as bone stock rebuild and provide mechanical stability with a maximum host bone contact [4]. Rings and cages are indicated for use in revision THA with severe bone loss, as those described in Paprosky classification, as types II and III [5]. The antiprotrusio cages are designed to manage extended pelvic defects by bridging large bone gaps and protecting the grafts filled to increase the bone stock [6]. We analyze the perioperative
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