Skip to main content
SpringerLink
Log in

Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Revision of failed total hip arthroplasty with massive acetabular bone loss resulting in pelvic discontinuity represents a rare but challenging problem. The objective of this study was to present short to mid-term results of revision total hip arthroplasty with a custom-made acetabular implant in a consecutive series of patients with pelvic discontinuity.

Methods

We retrospectively reviewed 18 consecutive patients with massive acetabular bone loss (Paprosky Type 3B) resulting in pelvic discontinuity reconstructed with revision total hip arthroplasty using a custom-made acetabular component. The prosthesis was created on the basis of a thin-cut 1-mm computed tomography (CT) scan of the pelvis. Initial stability of the implant was obtained by screw fixation. Harris hip score and sequential radiographs were used to evaluate the clinical and radiographic results.

Results

At an average follow up of 30 months (range 17–62 months) 16 of 18 (88.9 %) custom-made implants were considered radiographically stable without signs of acetabular migration of more than 2 mm in the horizontal or vertical direction, implant rotation or screw breakage. Complications included two periprosthetic joint infections treated with explantation of the implant. Three patients had recurrent dislocations postoperatively. The mean Harris hip score improved from 28 ± 12 points preoperatively to 69 ± 13 points at the time of last follow up.

Conclusion

Treatment of acetabular bone loss and pelvic discontinuity with a custom-made acetabular component can provide a durable solution with good clinical and radiographic results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785. doi:10.2106/JBJS.F.00222

    Article  PubMed  Google Scholar 

  2. Gravius S, Pagenstert G, Weber O, Kraska N, Rohrig H, Wirtz DC (2009) Acetabular defect reconstruction in revision surgery of the hip. Autologous, homologous or metal? Orthopade 38:729–740. doi:10.1007/s00132-009-1428-4

    Article  CAS  PubMed  Google Scholar 

  3. Gravius S, Randau T, Wirtz DC (2011) What can be done when hip prostheses fail?: new trends in revision endoprosthetics. Orthopade 40:1084–1094. doi:10.1007/s00132-011-1844-0

    Article  CAS  PubMed  Google Scholar 

  4. Friedrich MJ, Gravius S, Schmolders J, Wimmer MD, Wirtz DC (2014) Biological acetabular defect reconstruction in revision hip arthroplasty using impaction bone grafting and an acetabular reconstruction ring. Oper Orthop Traumatol 26(2):126–140. doi:10.1007/s00064-013-0270-3

    Article  CAS  PubMed  Google Scholar 

  5. Berry DJ (2004) Antiprotrusio cages for acetabular revision. Clin Orthop Relat Res 420:106–112

    Article  PubMed  Google Scholar 

  6. Perka C, Ludwig R, Stern S (2000) Total endoprosthetic management of the hip joint after failed osteosynthesis of para-articular hip fracture. Z Orthop Grenzgeb 138:39–45. doi:10.1055/s-2000-10111

    Article  CAS  Google Scholar 

  7. Whaley AL, Berry DJ, Harmsen WS (2001) Extra-large uncemented hemispherical acetabular components for revision total hip arthroplasty. J Bone Joint Surg Am 83-A:1352–1357

    CAS  PubMed  Google Scholar 

  8. Murphy SB (2005) Management of acetabular bone stock deficiency. J Arthroplast 20:85–90

    Article  Google Scholar 

  9. Beckmann NA, Weiss S, Klotz MC, Gondan M, Jaeger S, Bitsch RG (2014) Loosening after acetabular revision: comparison of trabecular metal and reinforcement rings a systematic review. J Arthroplasty 29:229–235. doi:10.1016/j.arth.2013.04.035

    Article  PubMed  Google Scholar 

  10. Abolghasemian M, Tangsataporn S, Sternheim A, Backstein D, Safir O, Gross AE (2013) Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss: a mid-term review. Bone Joint J 95-B:166–172. doi:10.1302/0301-620X.95B2.30608

    Article  CAS  PubMed  Google Scholar 

  11. Banerjee S, Issa K, Kapadia BH, Pivec R, Khanuja HS, Mont MA (2014) Systematic review on outcomes of acetabular revisions with highly-porous metals. Int Orthop 38:689–702. doi:10.1007/s00264-013-2145-5

    Article  PubMed  Google Scholar 

  12. Sakai T, Ohzono K, Nishii T, Takao M, Miki H, Nakamura N, Sugano N (2013) Modular acetabular reconstructive cup in acetabular revision total hip arthroplasty at a minimum ten year follow-up. Int Orthop 37:605–610. doi:10.1007/s00264-013-1818-4

    Article  PubMed Central  PubMed  Google Scholar 

  13. Gunther KP, Wegner T, Kirschner S, Hartmann A (2014) Modular reconstruction in acetabular revision with antiprotrusio cages and metal augments: the cage-and-augment system. Oper Orthop Traumatol 26:141–155. doi:10.1007/s00064-013-0271-2

    Article  PubMed  Google Scholar 

  14. Christie MJ, Barrington SA, Brinson MF, Ruhling ME, DeBoer DK (2001) Bridging massive acetabular defects with the triflange cup: 2- to 9-year results. Clin Orthop Relat Res 393:216–227

    Article  PubMed  Google Scholar 

  15. D’Antonio JA, Capello WN, Borden LS, Bargar WL, Bierbaum BF, Boettcher WG, Steinberg ME, Stulberg SD, Wedge JH (1989) Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res 243:126–137

    PubMed  Google Scholar 

  16. Paprosky WG, Perona PG, Lawrence JM (1994) Acetabular defect classification and surgical reconstruction in revision arthroplasty. A 6-year follow-up evaluation. J Arthroplast 9:33–44

    Article  CAS  Google Scholar 

  17. Wimmer MD, Randau TM, Petersdorf S, Pagenstert GI, Weisskopf M, Wirtz DC, Gravius S (2013) Evaluation of an interdisciplinary therapy algorithm in patients with prosthetic joint infections. Int Orthop 37:2271–2278. doi:10.1007/s00264-013-1995-1

    Article  PubMed Central  PubMed  Google Scholar 

  18. Harris WH (1969) Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty An end-result study using a new method of result evaluation. J Bone Joint Surg Am 51:737–755

    CAS  PubMed  Google Scholar 

  19. Berry DJ, Lewallen DG, Hanssen AD, Cabanela ME (1999) Pelvic discontinuity in revision total hip arthroplasty. J Bone Joint Surg Am 81:1692–1702

    CAS  PubMed  Google Scholar 

  20. Taunton MJ, Fehring TK, Edwards P, Bernasek T, Holt GE, Christie MJ (2012) Pelvic discontinuity treated with custom triflange component: a reliable option. Clin Orthop Relat Res 470:428–434. doi:10.1007/s11999-011-2126-1

    Article  PubMed Central  PubMed  Google Scholar 

  21. Peters CL, Curtain M, Samuelson KM (1995) Acetabular revision with the Burch-Schnieder antiprotrusio cage and cancellous allograft bone. J Arthroplast 10:307–312

    Article  CAS  Google Scholar 

  22. Azuma T, Yasuda H, Okagaki K, Sakai K (1994) Compressed allograft chips for acetabular reconstruction in revision hip arthroplasty. J Bone Joint Surg Br 76:740–744

    CAS  PubMed  Google Scholar 

  23. Wind MA Jr, Swank ML, Sorger JI (2013) Short-term results of a custom triflange acetabular component for massive acetabular bone loss in revision THA. Orthopedics 36:e260–e265. doi:10.3928/01477447-20130222-11

    Article  PubMed  Google Scholar 

  24. DeBoer DK, Christie MJ, Brinson MF, Morrison JC (2007) Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am 89:835–840. doi:10.2106/JBJS.F.00313

    Article  PubMed  Google Scholar 

  25. Holt GE, Dennis DA (2004) Use of custom triflanged acetabular components in revision total hip arthroplasty. Clin Orthop Relat Res 429:209–214

    Article  PubMed  Google Scholar 

  26. Kosashvili Y, Backstein D, Safir O, Lakstein D, Gross AE (2009) Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity. J Bone Joint Surg Br 91:870–876. doi:10.1302/0301-620X.91B7.22181

    Article  CAS  PubMed  Google Scholar 

  27. Pilge H, Gradl G, von Eisenhart-Rothe R, Gollwitzer H (2012) Incidence and outcome after infection of megaprostheses. Hip Int J Clin Exp Res Hip Pathol Ther 22(Suppl 8):S83–S90. doi:10.5301/HIP.2012.9576

    Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, University Clinic of Bonn, Sigmund Freud Str. 25, 53127, Bonn, Germany

    Max J. Friedrich, Jan Schmolders, Robert D. Michel, Thomas M. Randau, Matthias D. Wimmer, Hendrik Kohlhof, Dieter C. Wirtz & Sascha Gravius

Authors
  1. Max J. Friedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jan Schmolders
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Robert D. Michel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thomas M. Randau
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthias D. Wimmer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hendrik Kohlhof
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dieter C. Wirtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sascha Gravius
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Max J. Friedrich.

Additional information

Authors Max J. Friedrich and Jan Schmolders contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Friedrich, M.J., Schmolders, J., Michel, R.D. et al. Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty. International Orthopaedics (SICOT) 38, 2455–2461 (2014). https://doi.org/10.1007/s00264-014-2443-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-014-2443-6

Keywords

Search

Navigation