Clinical Orthopaedics and Related Research®

, Volume 470, Issue 11, pp 3156–3163

Acetabular Distraction: An Alternative for Severe Defects with Chronic Pelvic Discontinuity?

  • Scott M. Sporer
  • John J. Bottros
  • Jonah B. Hulst
  • Vamsi K. Kancherla
  • Mario Moric
  • Wayne G. Paprosky
Symposium: Papers Presented at the 2011 Meeting of the International Hip Society

DOI: 10.1007/s11999-012-2514-1

Cite this article as:
Sporer, S.M., Bottros, J.J., Hulst, J.B. et al. Clin Orthop Relat Res (2012) 470: 3156. doi:10.1007/s11999-012-2514-1

Abstract

Background

Stabilization of a pelvic discontinuity with a posterior column plate with or without an associated acetabular cage sometimes results in persistent micromotion across the discontinuity with late fatigue failure and component loosening. Acetabular distraction offers an alternative technique for reconstruction in cases of severe bone loss with an associated pelvic discontinuity.

Questions/Purposes

We describe the acetabular distraction technique with porous tantalum components and evaluate its survival, function, and complication rate in patients undergoing revision for chronic pelvic discontinuity.

Methods

Between 2002 and 2006, we treated 28 patients with a chronic pelvic discontinuity with acetabular reconstruction using acetabular distraction. A porous tantalum elliptical acetabular component was used alone or with an associated modular porous tantalum augment in all patients. Three patients died and five were lost to followup before 2 years. The remaining 20 patients were followed semiannually for a minimum of 2 years (average, 4.5 years; range, 2–7 years) with clinical (Merle d’Aubigné-Postel score) and radiographic (loosening, migration, failure) evaluation.

Results

One of the 20 patients required rerevision for aseptic loosening. Fifteen patients remained radiographically stable at last followup. Four patients had early migration of their acetabular component but thereafter remained clinically asymptomatic and radiographically stable. At latest followup, the average improvement in the patients not requiring rerevision using the modified Merle d’Aubigné-Postel score was 6.6 (range, 3.3–9.6). There were no postoperative dislocations; however, one patient had an infection, one a vascular injury, and one a bowel injury.

Conclusions

Acetabular distraction with porous tantalum components provides predictable pain relief and durability at 2- to 7-year followup when reconstructing severe acetabular defects with an associated pelvic discontinuity.

Level of Evidence

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

Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Scott M. Sporer
    • 1
    • 2
  • John J. Bottros
    • 1
  • Jonah B. Hulst
    • 1
  • Vamsi K. Kancherla
    • 3
  • Mario Moric
    • 1
  • Wayne G. Paprosky
    • 1
    • 2
  1. 1.Department of Orthopedic SurgeryRush University Medical CenterChicagoUSA
  2. 2.Department of Orthopedic SurgeryCentral Dupage HospitalWinfieldUSA
  3. 3.Department of Orthopedic SurgerySt Luke Health NetworkBethlehemUSA

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