Acetabular Revision With Intramedullary and Extramedullary Iliac Fixation for Pelvic Discontinuity |
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| Affiliation: | 1. Department of Orthopaedic Surgery, University of Wuerzburg, Wuerzburg, Germany;2. Department of Orthopaedics and Trauma Surgery, Medical University Vienna, Vienna General Hospital, Vienna, Austria;3. Regenerative Medicine, Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia;1. Department of Biomechanics, Hospital for Special Surgery, New York, NY;2. Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY;1. Orthopedic Research Unit, Aarhus University Hospital, Aarhus, Denmark;2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark;3. Department of Orthopaedic Surgery, Aarhus University Hospital, Aarhus, Denmark;4. Department of Radiology, Aarhus University Hospital, Aarhus, Denmark;5. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark;1. Department of Orthopedics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China;2. Department of Orthopedics, The People''s Hospital of Guang''an City, Guangan, China;1. Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, VA, USA;2. Carilion Clinic Department of Orthopaedics, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA;1. Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, C/ Doctor Esquerdo, 46, 28007, Madrid, Spain;2. Department of Traumatology and Orthopaedic Surgery Medcare Orthopaedics and Spine Hospital, Dubai, United Arab Emirates |
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| Abstract: | BackgroundParallel to the increase in revision hip procedures surgeons face more and more complex anatomical challenges with pelvic discontinuity (PD) being one of the worst-case scenarios. Here we report on our clinical results using an asymmetric acetabular component for the treatment of PD. The implant is armed in a monoblock fashion with an extramedullary iliac flange and provides the possibility to augment it with an intramedullary iliac press-fit stem.MethodsIn a single-center retrospective cohort study we analyzed prospectively collected data of 49 patients (35 female, 14 male) suffering from unilateral periprosthetic PD treated with an asymmetric acetabular component between 2009 and 2017. The mean follow-up was 71 months (21-114). Complications were documented and radiographic and functional outcomes were assessed.ResultsKaplan-Meier analysis revealed a 5-year implant survival of 91% (confidence interval 77%-96%). The 5-year survival with revision for any cause was 87% (CI 74%-94%). The overall revision rate was 16% (n = 8). Two patients required acetabular component revision due to aseptic loosening. Four patients (8%) suffered from periprosthetic infection: one patient was treated with a 2-stage revision, and another one with resection arthroplasty. The other 2 patients were treated with debridement, irrigation, and exchange of the mobile parts. Of 6 patients (12%) suffering from hip dislocation, 2 required implantation of a dual mobility acetabular component. The mean Harris Hip Score improved from 41 preoperatively to 79 at the latest follow-up (P < .001).ConclusionOur findings demonstrate that an asymmetric acetabular component with extramedullary and optional intramedullary iliac fixation is a reliable and safe treatment method for periprosthetic PD resulting in good clinical and radiographic mid-term results. |
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| Keywords: | pelvic discontinuity asymmetric cup revision hip arthroplasty acetabular bone defect periprosthetic |
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