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Acetabular Component Revision: Pelvic Discontinuity

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Discussion

(see also: classfication and bone graft options)

Technical Considerations

  • treatment may require insertion of posterior column reconstruction plate and a gap cup
  • intra operative exam findings:
    • observe for motion between the superior and the inferior hemipelvis when applying a caudal stress to the ischium with a blunt elevator;
  • w/ discontinuity and severe segmental bone loss and/or cavitary bone loss have worse prognosis than those w/o bone deficiencies;
  • reconstructive surgery which resulted in healing of the discontinuity generally was associated w/ good results;
  • w/ simple discontinuity, consider use of posterior column plate to stabilize the pelvis and a porous-coated socket inserted without cement;
  • w/ segmental deficiency, consider use of an antiprotrusio cage augmented w/ particulate bone graft or a single structural bone graft;
  • sciatic nerve: requires protection throughout the case

outcomes

Recognising & Treating Pelvic Discontinuity: Run or Refer