Background: Revision of a failed total hip arthroplasty with massive
acetabular bone loss and pelvic discontinuity is a reconstructive challenge.
This report presents the mid-term to long-term results of revision total hip
arthroplasty with a custom-made porous-coated triflange acetabular prosthesis
in a consecutive series of patients with pelvic discontinuity.
Methods: Twenty-eight consecutive patients (thirty hips) with a
failed total hip arthroplasty and pelvic discontinuity underwent revision
total hip arthroplasty. The prosthesis was custom-manufactured on the basis of
a three-dimensional model of the hemipelvis created with computed tomography.
Initial stability of the implant was provided with screw fixation. Two
patients did not return for follow-up after three months, and eight died and
were followed for less than seven years, leaving twenty hips in eighteen
patients followed for a mean of ten years. Harris hip scores and sequential
radiographs were used to evaluate the clinical and radiographic results.
Results: Definite healing of the pelvic discontinuity was indicated
by the presence of bridging callus in eighteen of the twenty hips. There were
no broken screws and no cases of implant migration, even when the
discontinuity persisted. Small nonprogressive radiolucent lines were observed
in six hips. Complications included one partial sciatic nerve palsy that
resolved completely and one case of loose ischial screws in a radiographically
stable implant in the same patient. Five patients had one or more dislocations
postoperatively. The mean Harris hip score improved from 41 points
preoperatively to 80 points at the time of the latest follow-up. Eleven of the
eighteen patients required ambulatory aids postoperatively. No component was
revised.
Conclusions: Performance of a revision total hip arthroplasty with a
custom triflange acetabular prosthesis to treat massive acetabular bone loss
and pelvic discontinuity can provide a durable solution with good clinical
results.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.