Management of pelvic discontinuity in revision arthroplasty : Cementless acetabular cup with iliac stem and cranial strap.

BACKGROUND: Pelvic discontinuity causes severe destruction of the acetabular bony walls and is particularly difficult to manage. This article reports the short-term results and complications encountered in the management of loosening of the acetabular cup with pelvic discontinuity using an acetabular cup with an intramedullary iliac stem combined with an extramedullary iliac plate.

MATERIAL AND METHODS: As part of this monocentric retrospective case analysis all patients who underwent acetabular revision surgery after THR due to loosening of the acetabular cup with pelvic discontinuity in this clinic from January 2016 to June 2017 were identified (n = 16). All patients underwent routine clinical and radiological follow-up. In addition, the Harris hip score (HHS) and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) were evaluated as part of a 1-year follow-up.

RESULTS: All patients were treated with an acetabular revision cup of appropriate size with intramedullary iliac stem combined with an anatomical extramedullary iliac plate. On clinical follow-up at 1 year (median follow-up time 14.5 ± 3.3 months), the average HHS was 69.3 ± 14.1 and the average WOMAC was 79.3 ± 11.7. Complications were registered in 7 out of the 16 patients whereby 1 showed aseptic loosening of the revision cup, dislocations were reported in 4 cases and infections in 2 cases. In the case of the two patients with infections a Girdlestone resection arthroplasty had to be performed.

CONCLUSION: The overall complications and postoperative outcome in revision surgery after THR reported in the literature were compared to the results of this study. Compared to the results of salvage procedures using large or bipolar heads and Girdlestone resection arthroplasty, satisfactory results were obtained using the acetabular cup with an intramedullary iliac stem combined with an extramedullary iliac plate.