Skip to main content
SpringerLink
Log in
Book cover

The Adult Hip - Master Case Series and Techniques pp 623–657Cite as

Acute and Chronic Pelvic Dissociation

  • Chapter
  • First Online:

  • 1034 Accesses

Abstract

PD is the loss of structural bone or fracture that separates completely the superior (ilium) from the inferior pelvis (ischiopubic segment) through the anterior and posterior columns of the acetabulum [1, 2]. It is a rare complication that ranges between 1 and 8% in revision THA series. Patients at risk are women, patients suffering from RA, and those with history of radiation therapy [1].

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

References

  1. Abdelnasser MK, Klenke FM, Whitlock P, Khalil AM, Khalifa YE, Ali HM, Siebenrock KA. Management of pelvic discontinuity in revision total hip arthroplasty: a review of the literature. Hip Int. 2015;25(2):120–6.

    Article  PubMed  Google Scholar 

  2. Schwarzkopf R, Ihn HE, Ries MD. Pelvic discontinuity: modern techniques and outcomes for treating pelvic disassociation. Hip Int. 2015;25(4):368–74.

    Article  PubMed  Google Scholar 

  3. Petrie J, Sassoon A, Haidukewych GJ. Pelvic discontinuity: current solutions. Bone Joint J. 2013;95-B(11 Suppl A):109–13.

    Article  CAS  PubMed  Google Scholar 

  4. D’Antonio JA, Capello WN, Borden LS, et al. Classification and management of acetabular abnormalities in total hip arthroplasty. Clin Orthop Relat Res. 1989;243:126–37.

    Google Scholar 

  5. Gross AE. Revision arthroplasty of the acetabulum with restoration of bone stock. Clin Orthop Relat Res. 1999;369:198–207.

    Article  Google Scholar 

  6. Berry DJ, Lewallen DG, Hanssen AD, Cabanela ME. Pelvic discontinuity in revision total hip arthroplasty. J Bone Joint Surg Am. 1999;81(12):1692–702.

    Article  CAS  PubMed  Google Scholar 

  7. Wendt MC, Adler MA, Trousdale RT, Mabry TM, Cabanela ME. Effectiveness of false profile radiographs in detection of pelvic discontinuity. J Arthroplasty. 2012;27(7):1408–12.

    Article  PubMed  Google Scholar 

  8. Giori NJ, Sidky AO. Lateral and high-angle oblique radiographs of the pelvis aid in diagnosing pelvic discontinuity after total hip arthroplasty. J Arthroplasty. 2011;26(1):110–2.

    Article  PubMed  Google Scholar 

  9. Chiang PP, Burke DW, Freiberg AA, Rubash HE. Osteolysis of the pelvis: evaluation and treatment. Clin Orthop Relat Res. 2003;417:164–74.

    Google Scholar 

  10. Leung S, Naudie D, Kitamura N, Walde T, Engh CA. Computed tomography in the assessment of periacetabular osteolysis. J Bone Joint Surg Am. 2005;87(3):592–7.

    Article  PubMed  Google Scholar 

  11. Bamberg F, Dierks A, Nikolaou K, Reiser MF, Becker CR, Johnson TR. Metal artifact reduction by dual energy computed tomography using monoenergetic extrapolation. Eur Radiol. 2011;21(7):1424–9.

    Article  PubMed  Google Scholar 

  12. Sporer SM, Bottros JJ, Hulst JB, Kancherla VK, Moric M, Paprosky WG. Acetabular distraction: an alternative for severe defects with chronic pelvic discontinuity? Clin Orthop Relat Res. 2012;470(11):3156–63.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Stiehl JB, Saluja R, Diener T. Reconstruction of major column defects and pelvic discontinuity in revision total hip arthroplasty. J Arthroplasty. 2000;15(7):849–57.

    Article  CAS  PubMed  Google Scholar 

  14. Eggli S, Muller C, Ganz R. Revision surgery in pelvic discontinuity: an analysis of seven patients. Clin Orthop Relat Res. 2002;398:136.

    Article  Google Scholar 

  15. Goodman S, Saastamoinen H, Shasha N, et al. Complications of ilioischial reconstruction rings in revision total hip arthroplasty. J Arthroplasty. 2004;19–4:436.

    Article  Google Scholar 

  16. Kerboull M, Hamadouche M, Kerboull L. The Kerboull acetabular reinforcement device in major acetabular reconstructions. Clin Orthop Relat Res. 2000;378:155–68.

    Article  Google Scholar 

  17. Paprosky WG, Sporer SS, Murphy BP. Addressing severe bone deficiency: what a cage will not do. J Arthroplasty. 2007;22(4 Suppl 1):111–5.

    Article  PubMed  Google Scholar 

  18. Rogers BA, Whittingham-Jones PM, Mitchell PA, Safir OA, Bircher MD, Gross AE. The reconstruction of periprosthetic pelvic discontinuity. J Arthroplasty. 2012;27(8):1499.e1–506.e1.

    Article  Google Scholar 

  19. Nicholas A, Beckmann MD. Loosening after acetabular revision: comparison of trabecular metal and reinforcement rings a systematic review. J Arthroplasty. 2014;29:229–35.

    Google Scholar 

  20. Rosson J, Schatzker J. The use of reinforcement rings to reconstruct deficient acetabula. J Bone Joint Surg Br. 1992;74–5:716.

    Article  Google Scholar 

  21. Gerber A, Pisan M, Zurakowski D, et al. Ganz reinforcement ring for reconstruction of acetabular defects in revision total hip arthroplasty. J Bone Joint Surg Am. 2003;85-A(12):2358.

    Article  PubMed  Google Scholar 

  22. Schlegel UJ, Bitsch RG, Pritsch M, et al. Acetabular reinforcement rings in revision total hip arthroplasty: midterm results in 298 cases. Orthopade. 2008;37–9(904):6.

    Google Scholar 

  23. Sporer SM, Paprosky WG. Acetabular revision using a trabecular metal acetabular component for severe acetabular bone loss associated with a pelvic discontinuity. J Arthroplasty. 2006;21–6(Suppl 2):87–90.

    Article  Google Scholar 

  24. Unger AS, Lewis RJ, Gruen T. Evaluation of a porous tantalum uncemented acetabular cup in revision total hip arthroplasty: clinical and radiological results of 60 hips. J Arthroplasty. 2005;20–8:1002.

    Article  Google Scholar 

  25. Weeden SH, Schmidt RH. The use of tantalum porous metal implants for Paprosky 3A and 3B defects. J Arthroplasty. 2007;22–6(Suppl 2):151.

    Article  Google Scholar 

  26. Siegmeth A, Duncan CP, Masri BA, et al. Modular tantalum augments for acetabular defects in revision hip arthroplasty. Clin Orthop Relat Res. 2009;467–1:199.

    Article  Google Scholar 

  27. Davies JH, Laflamme GY, Delisle J, et al. Trabecular metal used for major bone loss in acetabular hip revision. J Arthroplasty. 2011;26–8:1245.

    Article  Google Scholar 

  28. Flecher X, Sporer S, Paprosky W. Management of severe bone loss in acetabular revision using a trabecular metal shell. J Arthroplasty. 2008;23–7:949.

    Article  Google Scholar 

  29. Lingaraj K. The management of severe acetabular bone defects in revision hip arthroplasty using modular porous metal components. J Bone Joint Surg Br. 2009;91-B:1555–60.

    Article  Google Scholar 

  30. Del Gaizo DJ. Tantalum augments for paprosky IIIA defects remain stable at midterm follow up. Clin Orthop Relat Res. 2012;470:395–401.

    Article  PubMed  Google Scholar 

  31. Abolghasemian M, Tangsataporn S, Sternheim A, Backstein D, Safir O, Gross AE. Combined trabecular metal acetabular shell and augment for acetabular revision with substantial bone loss: a mid-term review. Bone Joint J. 2013;95-B:166–72.

    Article  CAS  PubMed  Google Scholar 

  32. Brown NM, Hellman M, Haughom BH, Shah RP, Sporer SM, Paprosky WG. Acetabular distraction: an alternative approach to pelvic discontinuity in failed total hip replacement. J Bone Joint Surg Br. 2014;96(11):73–7.

    Article  Google Scholar 

  33. Amenabar T, Rahman WA, Hetaimish BM, Kuzyk PR, Safir OA, Gross AE. Promising mid-term results with a cup-cage construct for large acetabular defects and pelvic discontinuity. Clin Orthop Relat Res. 2016;474:408–14.

    Article  PubMed  Google Scholar 

  34. Sheth NP, Nelson CL, Springer BD, Fehring TK, Paprosky WG. Acetabular bone loss in revision total hip arthroplasty: evaluation and management. J Am Acad Orthop Surg. 2013;21:128–39.

    Article  PubMed  Google Scholar 

  35. Abolghasemian M, et al. The challenge of pelvic discontinuity cup-cage reconstruction does better than conventional cages in mid-term. Bone Joint J. 2014;96-B:195–200.

    Article  CAS  PubMed  Google Scholar 

  36. Kosashvili Y, et al. 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. 2009;91-B:870–6.

    Article  Google Scholar 

  37. Goodman GP, Engh CA Jr. Acetabular Revision. The custom triflange cup. Build it and they will come. Bone Joint J. 2016;98-B(1 Suppl A):68–72.

    Article  CAS  PubMed  Google Scholar 

  38. Berasi CC IV, Berend KR, Adams JB, Ruh EL, Lombardi AV Jr. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res. 2015;473:528–35.

    Article  PubMed  Google Scholar 

  39. Taunton MJ, Fehring TK, Edwards P, et al. Pelvic discontinuity treated with custom triflange component: a reliable option. Clin Orthop Relat Res. 2012;470:428–34.

    Article  PubMed  Google Scholar 

  40. DeBoer DK, Christie MJ, Brinson MF, Morrison JC. Revision total hip arthroplasty for pelvic discontinuity. J Bone Joint Surg Am. 2007;89-A:835–40.

    Google Scholar 

  41. Holt GE, Dennis DA. Use of custom triflanged acetabular components in revision total hip arthroplasty. Clin Orthop Relat Res. 2004;429:209–14.

    Article  Google Scholar 

  42. Christie MJ, Barrington SA, Brinson MF, Ruhling ME, DeBoer DK. Bridging massive acetabular defects with the triflange cup: 2- to 9-year results. Clin Orthop Relat Res. 2001;393:216–27.

    Article  Google Scholar 

  43. Paprosky W, Sporer S, O’Rourke MR. The treatment of pelvic discontinuity with acetabular cages. Clin Orthop Relat Res. 2006;453(453):183–7.

    Article  PubMed  Google Scholar 

  44. García-Rey E, Madero R, García-Cimbrelo E. THA revisions using impaction allografting with mesh is durable for medial but not lateral acetabular defects. Clin Orthop Relat Res. 2015;473(12):3882–91.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Putzer D, Mayr E, Haid C, Reinthaler A, Nogler M. Impaction bone grafting: a laboratory comparison of two methods. J Bone Joint Surg Br. 2011;93(8):1049–53.

    Article  CAS  PubMed  Google Scholar 

  46. Coscujuela-Mañá A, Angles F, Tramunt C, Casanova X. Burch-Schneider antiprotrusio cage for acetabular revision: a 5- to 13-year follow-up study. Hip Int. 2010;20(Suppl 7):S112–8.

    Article  PubMed  Google Scholar 

  47. Regis D, Sandri A, Bonetti I, Bortolami O, Bartolozzi P. A minimum of 10- year follow-up of the Burch-Schneider cage and bulk allografts for the revision of pelvic discontinuity. J Arthroplast. 2012;27(6):1057–63.

    Article  Google Scholar 

  48. Kawanabe K, Akiyama H, Goto K, Maeno S, Nakamura T. Load dispersion effects of acetabular reinforcement devices used in revision total hip arthroplasty: a simulation study using finite element analysis. J Arthroplast. 2011;26(7):1061–6. doi:10.1016/j.arth.2011.04.019. Epub 2011 Jun 14

    Article  Google Scholar 

  49. Korzh NA, Filippenko VA, Mezentsev VA, Bondarenko SE. Reconstruction of acetabular defects in revision total hip arthroplasty. Traumatol Orthop. 2010;9(29):415–7.

    Google Scholar 

  50. Blumenfeld TJ. Implant choices, technique, and results in revision acetabular surgery: a review. Hip Int. 2012;22(3):235–47.

    Article  PubMed  Google Scholar 

  51. Pulido L, Rachala SR, Cabanela ME. Cementless acetabular revision: past, present, and future. Revision total hip arthroplasty: the acetabular side using cementless implants. Int Orthop. 2011;35(2):289–98.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Academic Orthopaedic Unit, Aristotle University Medical School, Thessaloniki, Greece

    Eustathios Kenanidis M.D., Ph.D., M.Sc.

  2. Academic Orthopaedic Unit, Papageorgiou General Hospital, Aristotle University Medical School, Thessaloniki, Greece

    Eleftherios Tsiridis M.D., Ph.D., F.A.C.S., F.R.C.S.

  3. Orthopaedic Surgery, Innsbruck, Austria

    Michael Nogler M.D.

  4. Orthopaedic Surgery, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, PA, USA

    Neil P. Sheth M.D.

  5. Massachusetts General Hospital, Boston, MA, USA

    Christopher M. Melnic M.D.

  6. Newton-Wellesley Hospital, Newton, MA, USA

    Christopher M. Melnic M.D.

  7. Harvard Medical School, Boston, MA, USA

    Christopher M. Melnic M.D.

  8. Midwest Orthopaedics at Rush University, Chicago, IL, USA

    Wayne G. Paprosky M.D

  9. Central DuPage Hospital—Northwestern University, Winfield, IL, USA

    Wayne G. Paprosky M.D

  10. ATOS Hospital Heidelberg, Heidelberg, Germany

    Fritz Thorey M.D., Ph.D.

  11. Department of Joint Pathology, Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine

    Stanislav Bondarenko M.D., Ph.D., Volodymyr Filippenko M.D. & Volodymyr Mezentsev M.D., Ph.D.

Authors
  1. Eustathios Kenanidis M.D., Ph.D., M.Sc.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eleftherios Tsiridis M.D., Ph.D., F.A.C.S., F.R.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Nogler M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Neil P. Sheth M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christopher M. Melnic M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wayne G. Paprosky M.D
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fritz Thorey M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Stanislav Bondarenko M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Volodymyr Filippenko M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Volodymyr Mezentsev M.D., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Aristotle University Medical School, Thessaloniki, Greece

    Eleftherios Tsiridis

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Cite this chapter

Kenanidis, E. et al. (2018). Acute and Chronic Pelvic Dissociation. In: Tsiridis, E. (eds) The Adult Hip - Master Case Series and Techniques. Springer, Cham. https://doi.org/10.1007/978-3-319-64177-5_32

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-64177-5_32

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64175-1

  • Online ISBN: 978-3-319-64177-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation