Construct Rigidity: Keystone for Treating Pelvic Discontinuity

Abstract

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Rapid Complete Acetabular Destruction in Metal-on-Metal Total Hip Arthroplasty

“…A polyethylene liner is then cemented into the construct in the appropriate amount of inclination and abduction. Revision survivorship with a cup-cage construct is excellent, with a study by Martin et al 3 reporting 100% 5-year revision-free implant survivorship.…”

“…Cup-cage constructs present a viable option for use in cases with severe acetabular defects leading to pelvic discontinuity, with good mid-term results reported. 3 …”

Pelvic discontinuity: a challenge to overcome

“…However, they stressed that six of the 11 hips with preoperative pelvic discontinuity either failed or developed a radiolucency in zone 3 (according to DeLee and Charnley zones) 32 and thus were considered at risk for future revision. In a recent large series, Martin et al 33 retrospectively reviewed 113 THA revisions, that presented PD. Ten patients (9%) were treated with a cup only.…”

“…Posterior column plating with compression of the fracture and grafting, along with a hemispheric high porous acetabular component is a more reasonable option for acute pelvic discontinuity and in selected cases of chronic pelvic discontinuity with good bone stock and biology. In Martins et al’s series, 33 50 hips (44%) were treated with posterior column plate and an uncemented cup. Five-year revision-free survivorship of the implant was 80% and healing of the PD was evident in 74% of the patients.…”

“…Other authors have presented mixed results. 4 , 17 , 33 According to Malahias et al’s 53 systematic review, with a mean follow-up time ranging from 35 to 162 months, the overall survival rate of ilioischial spanning cages in PD cases was 66.7%.…”