A novel approach to medial acetabular wall reconstruction in revision total hip arthroplasty using screwless porous metal augments: A report of two cases

Background Medial acetabular wall defects present unique reconstruction challenges in revision total hip arthroplasty (rTHA). Traditional approaches using bone grafts risk failure due to reabsorption due to poor vascular supply or minimal loading, while metal augments typically require screw fixation that poses neurovascular risks in the medial wall. We present a novel technique using screwless porous metal augments in medial acetabular reconstruction. Case report Two patients underwent rTHA for medial acetabular defects. Case 1 involved a 63-year-old woman with acetabular fracture and progressive protrusion after initial revision. Case 2 was an 85-year-old man with component loosening and medial migration. Both were reconstructed using free-floating trabecular metal augments placed within medial defects, supported by cancellous allograft and overlying porous metal cups. Short-term follow-up (3–6 months) demonstrated stable component positioning without migration in both cases. Conclusion Screwless porous metal augments represent a promising alternative for medial acetabular reconstruction, avoiding neurovascular risks while potentially providing an osteoconductive scaffold for bone restoration. Longer-term studies are needed to confirm biological integration and clinical durability.