7. Single outcome: acetabular revisionRESULTS Chronic Pelvic Discontinuity RESULTS Acute Pelvic Discontinuity ABSTRACT BACKGROUND: Periprosthetic pelvic discontinuity is a distinct form of bone loss in which the superior aspect of the hemipelvis is separated from the inferior aspect secondary to bone loss or a fracture through the acetabulum, and may be classified as acute or chronic. OBJECTIVE: This study details the surgical techniques and outcomes of acetabular reconstruction for both acute and chronic pelvic discontinuity treated at tertiary referral orthopaedic units. METHODS: This study identified 71 cases of pelvic discontinuity. Nine cases of acute pelvic discontinuity secondary to acute trauma were identified. There were 62 cases of chronic pelvic discontinuity, secondary to septic and aseptic periprosthetic bone loss. The mean age was 67 years, with a mean follow up of over 34 months for both groups. RESULTS: The mean fracture-to-surgery time for patients with acute pelvic discontinuity was 16.3 days, with eight patients (88%) having posterior column plating in addition to a porous metal acetabular cup augmented with screws. There was a single case of asymptomatic ischial non-union. No cases required revision surgery. Regarding the chronic pelvic discontinuity, twenty cases had an ilio-ischial cage, thirteen Burch-Schneider cages and seven ZCA cages, and 42 cases had a cup-cage reconstruction. The eight-year survivorship of the reconstructions was 86.3% using a Kaplan – Meier analysis. Five cases (8%) required revision surgery, three (4.8%) for a liner exchange or liner augmentation due to instability and two cases (3.2%) after 19 months for failed reconstructions. CONCLUSIONS: This study, the largest reported series, demonstrates that stable reconstruction of chronic pelvic discontinuity is achievable using ilio-ischial cages or a cup-cage reconstruction, the latter being preferable due to the beneficial biological and biomechanical properties of porous tantalum metal However, satisfactory stability of acute pelvic discontinuity can be achieved using screw augmentation of the acetabular shell supplemented by posterior column plating in some cases. N=9 compression 8 posterior column plate and uncemented cup At last follow up No revisions, 100% survivorship No dislocation/infection x1 radiographic ischialnon-union Kaplan – Meier survivorship graph for chronic pelvic discontinuity patients treated with cup-cage reconstruction. Any revision = end point. 86 % survivorship CONCLUSIONS [ Kaplan – Meier survivorship graph for chronic pelvic discontinuity patients treated with cup-cage reconstruction. Revision for a failed pelvic discontinuity reconstruction = end point. 93.8 % survivorship BA Rogers, D Backstein, O Safir, AE Gross Hip Revision Arthroplasty In AO Manual of Fracture Management: Periprosthetic Fractures CarstenPerka (Ed), 2011 For additional information please contact: Benedict Rogers, Dept of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada, benedictrogers@hotmail.com
![The Reconstruction of Periprosthetic Pelvic Discontinuity  BA Rogers1MA MSc MRCGP FRCS(orth), PM Whittingham-Jones2FRCS(orth), PA Mitchell2FRCS(orth), O Safir1MD FRCSC, D Backstein1 MD FRCSC, M Bircher2, FRCS, AE Gross1 MD FRCSC 1Division of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada. M5G 1X5, 2Department of Trauma & Orthopaedic Surgery, St George’s Hospital, London, UK. SW17 0QT METHODS ,[object Object]](https://image.slidesharecdn.com/boapelvicdisconposterv4-110904135632-phpapp02/85/Pelvic-Discontinuity-1-320.jpg)
