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Revision Total Hip Arthroplasty for Pelvic Discontinuity

¹ Southern Joint Replacement Institute, 2021 Church Street, Suite 104, Nashville, TN 37203. E-mail address for D.K. DeBoer: Martha.Brinson{at}sjri.com

Investigation performed at the Southern Joint Replacement Institute, Nashville, Tennessee

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from DePuy Orthopaedics, a Johnson and Johnson company. In addition, one or more of the authors or a member of his or her immediate family received, in any one year, payments or other benefits in excess of $10,000 or a commitment or agreement to provide such benefits from a commercial entity (DePuy Orthopaedics, a Johnson and Johnson company). Also, a commercial entity (DePuy Orthopaedics, a Johnson and Johnson company) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: Twenty-eight consecutive patients (thirty hips) with a failed total hip arthroplasty and pelvic discontinuity underwent revision total hip arthroplasty. The prosthesis was custom-manufactured on the basis of a three-dimensional model of the hemipelvis created with computed tomography. Initial stability of the implant was provided with screw fixation. Two patients did not return for follow-up after three months, and eight died and were followed for less than seven years, leaving twenty hips in eighteen patients followed for a mean of ten years. Harris hip scores and sequential radiographs were used to evaluate the clinical and radiographic results.

Results: Definite healing of the pelvic discontinuity was indicated by the presence of bridging callus in eighteen of the twenty hips. There were no broken screws and no cases of implant migration, even when the discontinuity persisted. Small nonprogressive radiolucent lines were observed in six hips. Complications included one partial sciatic nerve palsy that resolved completely and one case of loose ischial screws in a radiographically stable implant in the same patient. Five patients had one or more dislocations postoperatively. The mean Harris hip score improved from 41 points preoperatively to 80 points at the time of the latest follow-up. Eleven of the eighteen patients required ambulatory aids postoperatively. No component was revised.

Conclusions: Performance of a revision total hip arthroplasty with a custom triflange acetabular prosthesis to treat massive acetabular bone loss and pelvic discontinuity can provide a durable solution with good clinical results.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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