The jumbo cup: Curtain calls and caveats
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)
- et al.
The fate of cementless jumbo cups in revision hip arthroplasty
Journal of Arthroplasty
(2003) - et al.
Use of jumbo cups for of acetabulae with large bony defects
Journal of Arthroplasty
(2014) - et al.
The jumbocup: the 95% solution
Seminars in Arthroplasty
(2013) - et al.
Does ischial screw fixation improve mechanical stability in revision total hip arthroplasty?
Journal of Arthroplasty
(2010) - et al.
Leg-length discrepancy after revision hip arthroplasty: are modular stems superior?
Journal of Arthroplasty
(2013) - et al.
Acetabular cup revision with the use of the medial protrusio technique at an average follow-up of 6.6 years
Journal of Arthroplasty
(2010) - et al.
Oversized acetabular socket causing groin pain after total hip arthroplasty
Journal of Arthroplasty
(2009) - et al.
Oversized cups as a major risk factor of postoperative pain after total hip arthroplasty
Journal of Arthroplasty
(2014) - et al.
Iliopsoas tendonitis. A complication after total hip arthroplasty
Journal of Arthroplasty
(2007) Use of an anatomical acetabular component for treatment of iliopsoas impingement
Journal of Arthroplasty
(2011)
Iliopsoas tendonitis following total hip arthroplasty: how effective are selective steroid injections in treating this uncommon cause of groin pain?
Journal of Arthroplasty
The management of severe acetabular bone loss using structural allograft and acetabular reinforcement devices
Journal of Arthroplasty
Complications of ilioischial reconstruction rings in revision total hip arthroplasty
Journal of Arthroplasty
The use of a trabecular metal acetabular component and trabecular metal augment for severe acetabular defects
Journal of Arthroplasty
Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty
Journal of Bone and Joint Surgery
Cited by (2)
Difficult revision total hip arthroplasty cases treated with an offset head center acetabular shell
2019, Surgical Technology InternationalNovel Acetabular Cup for Revision THA Improves Hip Center of Rotation: A Radiographic Evaluation
2018, Clinical Orthopaedics and Related Research