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Complex Revision Total Hip Arthroplasty in Patients With Extensive Bone Loss and Pelvic Discontinuity

March 01, 2020

Contributors: William John Long, MD, FAAOS; Dylan Lowe, MD; James D Slover, MD, FAAOS; Greg Teo, MD; Jonathan D Haskel, MD

Keywords: Bone Loss

Patients who have undergone one or more total hip arthroplasty (THA) procedures may experience acetabular bone loss, which may range from mild femoral head migration to severe osteolysis requiring complex surgical reconstruction. Multiple revision THA procedures may be associated with catastrophic global erosion of the acetabulum, with attenuation or destruction of all supporting structures. Custom acetabular components should be considered in these patients. Custom acetabular components afford immediate, rigid fixation with a superior fit individualized to each patient. Patients require preoperative CT with three-dimensional reconstruction to determine the exact location, length, and number of screws preoperatively. The use of a triflange acetabular implant is a viable surgical option for the management of pelvic discontinuity, facilitating functional ambulation, bony healing, and osseointegration of the implant with the underlying bone. This video demonstrates revision THA with the use of a patient-specific triflange acetabular implant in a patient with pelvic discontinuity secondary to considerable osteolysis who has undergone multiple surgical procedures. An overview of the diagnosis, preoperative planning, and management of pelvic discontinuity is provided. The case presentation of a 69-year-old man with chronic hip pain in whom multiple surgical management attempts have failed is discussed. The patient has radiographic evidence of circumferential bone resorption about the acetabular implant with extension into the ischium. Revision THA with the use of a patient-specific triflange acetabular implant was performed. The patient was admitted postoperatively and discharged on hospital day four. Partial weight bearing was allowed immediately postoperatively, and the patient ambulated on postoperative day one. Ambulation to full weight bearing occurred within 30 days postoperatively, after which time the patient initiated range of motion activities and stationary bike exercises. The patient could internally and externally rotate his hip against resistance, had equal leg lengths, had range of motion from 0° to 120°, and had an improved Trendelenburg gait. At 3 months postoperatively, the patient was continuing rehabilitation via self-directed physical therapy and was expected to improve by 18 to 24 months postoperatively. The use of a custom triflange acetabular component is a reliable option for the management of extensive bone loss in patients undergoing revision THA. Promising clinical and radiographic outcomes have been reported in the literature.

Results for "Adult Reconstruction"

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