The jumbo cup: Curtain calls and caveats

https://doi.org/10.1053/j.sart.2014.04.011Get rights and content

Abstract

Use of an oversized “jumbo cup” is an effective technique for revision of most failed acetabular components. The jumbo cup is prepared with hemispherical reamers and provides a large porous ingrowth surface area in direct contact with the host bone. However, since the oversized cup is larger than the native acetabulum, the hip center can be raised, which may require use of a longer femoral head to maintain soft tissue tension and leg length. The anterior edge of the cup may also protrude through the anterior wall, which could be a cause of iliopsoas tendonitis resulting in groin pain.

Introduction

Acetabular revision total hip arthroplasty (THA) with use of a large (jumbo) cementless cup is an effective treatment for many cavitary and moderate-sized segmental peripheral bone defects. A jumbo cup has been defined as 62 mm or larger in females and 66 mm or larger in males [1], [2]. This is approximately 10 mm larger in diameter than the average male and female native acetabulum. The jumbo component provides a broad porous-coated surface area for ingrowth. Cavitary defects are filled with morselized bone graft. The cup is supported directly on the host bone so the bone graft is not load bearing. Many studies have shown that a cementless porous-coated jumbo cup fixed with screws achieves satisfactory clinical results in revision THA [1], [2], [3], [4], [5], [6]. Survivorship rates of over 95% at 10 years and 90% at 15 years have been reported [1], [2], [3].

Section snippets

Jumbo cup technique

Reaming for the jumbo cup requires sequentially increasing-sized reamers to provide a hemispherical shape to the remaining acetabular bone bed. The cup is ideally supported on superior, anterior, and posterior bone. The anterior wall may be reamed away during preparation for the jumbo cup, which can still provide posterior, superior, and anterosuperior host bone support [3]. Cavitary and small segmental defects are filled with morselized autograft obtained from reamings or allograft. Although

Issues with jumbo cups

The jumbo cup is larger than the physiologic size of the native acetabulum, which may result in elevation of the hip center (Fig. 2) [9], [10]. Hip center elevation can occur from reaming superiorly to place the cup directly on viable host bone (high hip center) and/or due to the increased diameter of the oversized cup compared to the native acetabulum [9], [11]. In a computer simulation of jumbo cup revision THA, the hip center was elevated 0.27 mm superiorly and 0.02 mm anteriorly, and anterior

Alternatives to jumbo cup

Large segmental bone defects (Paprosky type 3B and discontinuities) require more extensive reconstructive methods such as a cup/cage, custom triflange, and structural bone grafts or metal augmentation. Most bone defects that can be treated with a jumbo cup are cavitary and posterosuperior segmental defects that effectively result in an oblong acetabular cavity. These can be treated by reaming the oblong cavity into a large hemispherical shape for the jumbo cup, by placement of a cup in a high

References (31)

  • R. Nunley et al.

    Iliopsoas tendonitis following total hip arthroplasty: how effective are selective steroid injections in treating this uncommon cause of groin pain?

    Journal of Arthroplasty

    (2009)
  • T.J. Gill et al.

    The management of severe acetabular bone loss using structural allograft and acetabular reinforcement devices

    Journal of Arthroplasty

    (2000)
  • S. Goodman et al.

    Complications of ilioischial reconstruction rings in revision total hip arthroplasty

    Journal of Arthroplasty

    (2004)
  • S.M. Sporer et al.

    The use of a trabecular metal acetabular component and trabecular metal augment for severe acetabular defects

    Journal of Arthroplasty

    (2006)
  • A.L. Whaley et al.

    Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty

    Journal of Bone and Joint Surgery

    (2001)
  • View full text