This retrospective study evaluated a single surgeon's series of patients treated by multilevel cervical disc excision (two or three levels), allograft tricortical iliac crest arthrodesis, and anterior instrumentation. The objective of this retrospective study was to compare fusion success and clinical outcome between multilevel Smith-Robinson interbody grafting and tricortical iliac strut graft reconstruction, both supplemented with anterior instrumentation in the cervical spine. The incidence of nonunion for cervical discectomy and fusion varies widely depending on the number of disc levels involved, type of bone graft used, and whether the anterior grafting is supplemented with instrumentation. An alternative to multilevel interbody fusion is corpectomy and strut grafting, in which the incidence of nonunion has been reported to be 27% with autograft and 41% with allograft. Sixty-four consecutive patients who underwent allograft tricortical iliac crest reconstruction and anterior cervical plating were studied. The average follow-up was 39 months. There were 38 patients in the discectomy and interbody grafting group and 26 patients in the corpectomy and strut graft reconstruction group. Pseudoarthrosis occurred in 42% of the anterior cervical interbody fusion patients and 31% of the corpectomy patients. Nonunion in two-level interbody fusions occurred in 36% of the patients as compared to 10% for patients with one-level corpectomies; while 54% of patients with three-level interbody fusions and 44% of patients with two-level corpectomies were noted to have pseudoarthrosis. Higher percentages of nonunion were noted in multilevel interbody grafting than in corpectomy with strut grafting and when more vertebral levels were involved. These radiographic and clinical findings underscore the shortcomings of multilevel anterior cervical allograft reconstruction with plating. Corpectomy may be the preferred method when multiple disc levels are fused. In addition, anterior corpectomy affords decompression of significant osteophytes in a safer and quicker manner. In retrospective studies, there is a need for long-term followup before accurate statements can be made about the study population.

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Managing severe periacetabular bone loss during revision total hip arthroplasty (THA) is a challenging task. Multiple treatment options have been described. A custom triflanged acetabular component is a recent treatment option. The authors retrospectively reviewed 19 hips in 19 patients with massive periacetabular bone loss (Paprosky types 3A/3B and AAOS types III/IV) treated with custom triflanged acetabular components. Mean patient age at surgery was 58 years (range, 42-79 years).At an average follow-up of 31 months (range, 16-59 months), mean Harris Hip Score had improved from 38 preoperatively to 63 postoperatively, and mean Western Ontario McMaster Osteoarthritis Index scores had improved from 43 preoperatively to 26 postoperatively. Sixty-five percent of cases were considered successful. Three (16%) patients had significant complications; 2 (11%) custom triflanged acetabular components were removed due to failure. At last follow-up, 6 (43%) of 14 patients reported that their ambulatory status was improved vs their preoperative status, 3 (21%) reported no change, and 5 (36%) reported that their ambulatory status was worse than their preoperative status.In this study, the use of a custom triflanged acetabular component for massive periacetabular bone loss in revision THA had less favorable results than in other reports. Use of a custom triflanged acetabular component for massive periacetabular bone loss in revision THA remains a viable option, but surgeon and patient expectations should be realistic.

Although the control group was found to be higher functioning preoperatively, there was no statistically significant difference in flexion, edema or drainage, function, or pain between groups through the 3-month study period.

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