Pelvic Discontinuity Associated With Total Hip Arthroplasty: Evaluation and Management

J Am Acad Orthop Surg. 2017 May;25(5):330-338. doi: 10.5435/JAAOS-D-15-00260.

Abstract

Pelvic discontinuity is a challenging complication encountered during revision total hip arthroplasty. Pelvic discontinuity is defined as a separation of the ilium superiorly from the ischiopubic segment inferiorly and is typically a chronic condition in failed total hip arthroplasties in the setting of bone loss. After a history and a physical examination have been completed and infection has been ruled out, appropriate imaging must be obtained, including plain hip radiographs, oblique Judet radiographs, and often a CT scan. The main management options are a hemispheric acetabular component with posterior column plating, a cup-cage construct, pelvic distraction, and a custom triflange construct. The techniques have unique pros and cons, but the goals are to obtain stable and durable acetabular component fixation and a healed or unitized pelvis while minimizing complications.

Publication types

  • Review

MeSH terms

  • Acetabulum
  • Arthroplasty, Replacement, Hip*
  • Bone Diseases / diagnosis
  • Bone Diseases / surgery*
  • Bone Plates
  • Hip Prosthesis
  • Humans
  • Ilium* / diagnostic imaging
  • Ilium* / injuries
  • Ischium* / diagnostic imaging
  • Ischium* / injuries
  • Osteogenesis, Distraction
  • Postoperative Complications
  • Prosthesis Design
  • Prosthesis Failure
  • Pubic Bone* / diagnostic imaging
  • Pubic Bone* / injuries
  • Reoperation