Acetabular reinforcement rings associated with allograft for severe acetabular defects

Acetabular revisions with severe bone defects can be challenging procedures. Several grading systems have been set into place to help the surgeon adequately gauge the degree of bone loss within the acetabulum. Internationally innovative research in orthopedics and bio-engineering has helped with progression of successful techniques and rings to re-establish the normal anatomy of the hip. The purpose of this review is to evaluate the outcomes of the different acetabular reinforcement rings in the setting of severe acetabular defects. A successive report of relevant data from the literature of multiple techniques will be provided. The procedures include the cup-cage, the Muller ring, the Ganz Ring, the Kerboull acetabular reinforcement device (KARD), the graft augmentation prosthesis (GAP) ring, and the Burch-Schneider ring. The main focus of this overview is rings only; other devices such as trabecular augments, custom-made cages, or oblong cups are not discussed. Furthermore, a special emphasis on the surgical technique of the KARD is also given. Procedures using these rings are usually associated with bone grafts either bulk or morselized. When considering the available data on these various rings used for reconstruction of the severely damaged acetabulum, the cup-cage, the KARD, and the Burch-Schneider ring appear to be reliable options for more successful long-term outcomes.