, Volume 470, Issue 2, pp 428-434
Date: 14 Oct 2011

Pelvic Discontinuity Treated With Custom Triflange Component: A Reliable Option

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Abstract

Background

Pelvic discontinuity is an increasingly common complication of THA. Treatments of this complex situation are varied, including cup-cage constructs, acetabular allografts with plating, pelvic distraction technique, and custom triflange acetabular components. It is unclear whether any of these offer substantial advantages.

Questions/purposes

We therefore determined (1) revision and overall survival rates, (2) discontinuity healing rate, and (3) Harris hip score (HHS) after treatment of pelvic discontinuity with a custom triflange acetabular component and (4) the cost of this reconstructive operation compared to other constructs.

Methods

We retrospectively reviewed 57 patients with pelvic discontinuity treated with revision THA using a custom triflange acetabular component. We reviewed operative reports, radiographs, and clinical data for clinical and radiographic results. We also performed a cost comparison with utilization of other techniques. Minimum followup was 24 months (average, 65 months; range, 24–215 months).

Results

Fifty-six of 57 (98%) were free of revision for aseptic loosening at latest followup. Fifty-four (95%) were free of revision of the triflange component for any reason. Thirty-seven (65%) were free of revision for any reason. Twenty-eight (49%) were free of revision for any reason and free of any component migration and had a healed discontinuity. Forty-six (81%) had a stable triflange component with a healed pelvic discontinuity. Average HHS was 74.8. The costs of the custom triflange implants and a Trabecular Metal® cup-cage construct were equivalent: $12,500 and $11,250, respectively.

Conclusions

In this group of patients with osteolytic pelvic discontinuity, triflange implants provided predictable mid-term fixation at a cost equivalent to other treatment methods.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Thomas K. Fehring has received royalties, has made speakers bureau/paid presentations, is a paid consultant, and has received research support from DePuy Orthopaedics, Inc, a Johnson & Johnson company (Warsaw, IN, USA); and is a board member/committee appointment for American Association of Hip and Knee Surgeons (Rosemont, IL, USA) and The Knee Society (Rosemont, IL, USA). Thomas Bernasek has received royalties and is a paid consultant for DePuy. Ginger E. Holt is a board member/committee appointment for the Ruth Jackson Orthopaedic Society (Rosemont, IL, USA). Michael J. Christie has received royalties from DePuy and owns stock or stock options in Exactech, Inc (Gainesville, FL, USA). The remaining authors certify that they have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
Clinical Orthopaedics and Related Research neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use.
Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.
This work was performed at OrthoCarolina.