Favorable 17-Year Outcome of a Bulk Femoral Head Allograft Combined With a Burch-Schneider Antiprotrusio Cage in Revision Total Hip Arthroplasty for Severe Acetabular Osteolysis and Pelvic Discontinuity: A Case Report.

Acetabular revision in total hip arthroplasty (THA) complicated by massive bone loss and pelvic discontinuity remains a major surgical challenge, requiring restoration of bone stock and immediate mechanical stability. This case report describes the long-term clinical and radiographic outcome of a 63-year-old woman who presented with progressive right groin pain, limb-length discrepancy, and a Trendelenburg gait five years after undergoing a cemented THA. Radiographs demonstrated severe acetabular periprosthetic osteolysis with pelvic discontinuity, classified as a Paprosky type IIIB defect. Reconstruction was performed using a cryopreserved bulk femoral head allograft and cryopreserved morselized cancellous bone. Both bone allografts were procured from a single young adult deceased donor. Primary mechanical stability was achieved with a Burch-Schneider (Zimmer Biomet, IN, USA) anti-protrusio cage and a cemented polyethylene cup, while the well-fixed cemented femoral stem was retained. At the 17-year follow-up, the reconstructed right hip remained pain-free, and the patient reported high satisfaction. Radiographs demonstrated stable fixation, radiographic evidence of allograft incorporation, and no recurrent periprosthetic osteolysis or graft resorption. In this case, close graft-host apposition, cancellous bone impaction grafting, and stable cage fixation may have contributed to successful allograft incorporation and preservation of acetabular bone stock. Although porous metal implants and custom triflange components are contemporary alternatives, this reconstruction was associated with a favorable 17-year clinical and radiographic outcome in a patient with severe acetabular bone loss and pelvic discontinuity.