Acetabular revision using an anti-protrusion (ilio-ischial) cage and trabecular metal acetabular component for severe acetabular bone loss associated with pelvic discontinuity

• Published in: Journal of bone and joint surgery. British volume Vol. 91; no. 7; pp. 870 - 876
• Main Authors: KOSASHVILI, Y, BACKSTEIN, D, SAFIR, O, LAKSTEIN, D, GROSS, A. E
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01-07-2009; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Acetabulum - diagnostic imaging; Acetabulum - surgery; Acetabulum - transplantation; Adult; Aged; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - methods; Biological and medical sciences; Diseases of the osteoarticular system; Female; Fracture Fixation, Internal - methods; Humans; Male; Malformations and congenital and or hereditary diseases involving bones. Joint deformations; Medical sciences; Middle Aged; Orthopedic surgery; Osteolysis - complications; Osteolysis - diagnostic imaging; Osteolysis - surgery; Osteoporosis. Osteomalacia. Paget disease; Prosthesis Design; Prosthesis Failure; Radiography; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Treatment Outcome; Young Adult; Reoperation; Cage; Orthopedic surgery; Treatment; Diseases of the osteoarticular system; Acetabular protrusion; Acetabulum; Metal; Osteopenia
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.91B7.22181

Pelvic discontinuity with associated bone loss is a complex challenge in acetabular revision surgery. Reconstruction using ilio-ischial cages combined with trabecular metal acetabular components and morsellised bone (the component-cage technique) is a relatively new method of treatment. We reviewed a consecutive series of 26 cases of acetabular revision reconstructions in 24 patients with pelvic discontinuity who had been treated by the component-cage technique. The mean follow-up was 44.6 months (24 to 68). Failure was defined as migration of a component of > 5 mm. In 23 hips (88.5%) there was no clinical or radiological evidence of loosening at the last follow-up. The mean Harris hip score improved significantly from 46.6 points (29.5 to 68.5) to 76.6 points (55.5 to 92.0) at two years (p < 0.001). In three hips (11.5%) the construct had migrated at one year after operation. The complications included two dislocations, one infection and one partial palsy of the peroneal nerve. Our findings indicate that treatment of pelvic discontinuity using the component-cage construct is a reliable option.