case_images: PMC10831581_01
case_images: A preoperative radiograph shows complete intrapelvic cup protrusion, pelvic discontinuity with complete distortion of the medial acetabular wall, and excessive osteolysis and absorption of the iliac bone.
case_images: cureus-0016-00000051498-i01.jpg
case_images: PMC10831581_01_cureus-0016-00000051498-i01.jpg
case_images: FIG1
case_images: Extensive bone absorption was also present at the proximal femoral shaft region, while the shaft was fixed in the varus position (Figure 1).
case_images: A non-enhanced axial CT showing a hyperdense mass-like lesion surrounding the protruded cup (A), lymph nodes surrounding the lesion (B), and significant displacement of the bowel, bladder, and uterus (C).
case_images: cureus-0016-00000051498-i02.jpg
case_images: PMC10831581_01_cureus-0016-00000051498-i02.jpg
case_images: FIG2
case_images: The CT scan showed a hyperdense mass-like lesion surrounding the protruded cup in the right hemipelvis (Figure 2A). Multiple hyperdense lymph nodes were surrounding the lesion, with maximum dimensions of 11x23 mm (Figure 2B). Consequently, a mass effect was identified, with significant displacement of the bowel, bladder, and uterus (Figure 2C).
case_images: A 3D reconstruction demonstrating existing bone loss. 3D: three-dimensional
case_images: cureus-0016-00000051498-i03.jpg
case_images: PMC10831581_01_cureus-0016-00000051498-i03.jpg
case_images: FIG3
case_images: Acetabular bone loss was classified as Paprosky type IV (Figures 3A, 3B).
case_images: Digital subtraction angiography demonstrated no arterial injuries to the external and internal iliac arteries (EIA, IIA), superior gluteal artery (SGA), the anterior trunk of the internal iliac artery (IIA-AT), as well as the superficial and deep femoral arteries (SFA, DFA).
case_images: cureus-0016-00000051498-i04.jpg
case_images: PMC10831581_01_cureus-0016-00000051498-i04.jpg
case_images: FIG4
case_images: Intraoperative images demonstrate the protruded cup left in situ (A), a well-fixed tantalum cup (B) reinforced by a short, short-flange titanium acetabular cage (C), and the placement of a cemented polyethylene-bearing surface (D).
case_images: cureus-0016-00000051498-i05.jpg
case_images: PMC10831581_01_cureus-0016-00000051498-i05.jpg
case_images: FIG5
case_images: A cemented polyethylene-bearing surface with a diameter of 32 mm was placed (Figures 5A-5D).
case_images: Postoperative radiograph following acetabular reconstruction while maintaining the protruded cup.
case_images: cureus-0016-00000051498-i06.jpg
case_images: PMC10831581_01_cureus-0016-00000051498-i06.jpg
case_images: FIG6
case_images: No signs of instability were identified, a draining tube was placed, and the incision was closed in the usual manner (Figure 6).
case_images: Postoperative radiograph after the placement of a constrained polyethylene inlet.
case_images: cureus-0016-00000051498-i07.jpg
case_images: PMC10831581_01_cureus-0016-00000051498-i07.jpg
case_images: FIG7
case_images: The decision was made to revise the previous surgery using a constrained acetabular insert (Trident  Constrained Acetabular Insert, Stryker , Kalamazoo, MI) this time (Figure 7).