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Description: As the number of revision total hip arthroplasty increases, innovative solutions to complex problems are needed to address challenges posed by these complex cases. Severe acetabular bone loss, including cases of pelvic discontinuity, is a notable challenge with few solutions. Hip instability after revision arthroplasty remains one of the leading causes of revision and patient morbidity. The use of pelvic distraction and a press-fit tantalum shell for chronic discontinuity and posterior column open reduction and internal fixation with acetabular revision for acute pelvic discontinuity have previously been described. Similarly, dual mobility articulations have demonstrated long-term success in minimizing instability after revision total hip arthroplasty with good long-term survivorship. Here, the authors present a surgical technique in the management of Paprosky types 2 and 3 acetabular defects often with pelvic discontinuity using a tantalum shell in combination with cemented dual mobility liner to increase the stability of the joint. Custom screw placement is facilitated with the use of a metal cutting burr, both on the back table and in situ. The dual mobility liner is cemented, thus allowing for independent positioning of the acetabular implant and bearing surface. This technique has been successfully used in 19 patients with encouraging short-term results.
1. Review the evaluation and treatment of acetabular bone loss pre-operatively with an emphasis on intra-operative reassessment
2. Discuss the treatment options for various Paprosky acetabular bone loss patterns
3. Review the diagnosis and treatment strategies for acute and chronic pelvic discontinuity
4. Discuss the biomechanical advantages of supplemental screw fixation with an emphasis on screw placement in the ischium and ramus
5. Review the available literature on dual mobility bearing revision total hip arthroplasty
6. Describe and review the technical aspects of the surgical technique described in the article
Charles Nelson, MD.
Christopher M. Melnic, MD.
Wayne B. Cohen-Levy, MD, MSc.
Santiago A. Lozano-Calderon
The American Academy of Orthopaedic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education (CME) for physicians. The American Academy of Orthopaedic Surgeons designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.