TY - JOUR
T1 - Acetabular Distraction Technique for the Treatment of Chronic Pelvic Discontinuities
T2 - Excellent Short-Term Implant Survivorship and Good Clinical Outcomes
AU - Bingham, Joshua S.
AU - Arthur, Jaymeson R.
AU - Trousdale, Robert T.
AU - Lewallen, David G.
AU - Berry, Daniel J.
AU - Abdel, Matthew P.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/10
Y1 - 2020/10
N2 - Background: Pelvic discontinuity is a challenging complication in revision total hip arthroplasty. One technique that has garnered enthusiasm with limited data is acetabular distraction. Acetabular distraction provides stability via elastic recoil of the pelvis. The aim of this study is to report implant survivorship, radiographic results, clinical outcomes, and complications in the largest independent series of discontinuities treated with acetabular distraction. Methods: We retrospectively identified all revision total hip arthroplasties with a pelvic discontinuity between 2005 and 2017. Of the 162 patients, 31 were treated with distraction. Mean age was 67 years, with 71% female. Mean body mass index was 28 kg/m2, and mean follow-up was 3 years. Results: The 2-year survivorship free from revision for aseptic loosening, re-revision for any reason, and reoperation were 97%, 93%, and 87%, respectively. There were 3 re-revisions including 1 for aseptic loosening, 1 conversion to a dual mobility for instability, and 1 two-stage exchange for infection. At last follow-up, 3 acetabular components did not have evidence of osteointegration. Only patients with osteointegration to both the ilium and ischium had evidence of a healed discontinuity. The mean Harris Hip Score improved from 43 preoperatively to 77 postoperatively (P < .0001). The most common complication was a partial sciatic nerve palsy that occurred in 4 patients. Conclusion: In this series utilizing pelvic distraction, there was excellent 2-year survivorship free from revision for aseptic loosening. Despite several discontinuities persisting, 90% of patients had radiographic evidence of implant osteointegration, and clinical outcomes improved significantly. The most common complication was a partial sciatic nerve palsy. Level of Evidence: IV Case Series.
AB - Background: Pelvic discontinuity is a challenging complication in revision total hip arthroplasty. One technique that has garnered enthusiasm with limited data is acetabular distraction. Acetabular distraction provides stability via elastic recoil of the pelvis. The aim of this study is to report implant survivorship, radiographic results, clinical outcomes, and complications in the largest independent series of discontinuities treated with acetabular distraction. Methods: We retrospectively identified all revision total hip arthroplasties with a pelvic discontinuity between 2005 and 2017. Of the 162 patients, 31 were treated with distraction. Mean age was 67 years, with 71% female. Mean body mass index was 28 kg/m2, and mean follow-up was 3 years. Results: The 2-year survivorship free from revision for aseptic loosening, re-revision for any reason, and reoperation were 97%, 93%, and 87%, respectively. There were 3 re-revisions including 1 for aseptic loosening, 1 conversion to a dual mobility for instability, and 1 two-stage exchange for infection. At last follow-up, 3 acetabular components did not have evidence of osteointegration. Only patients with osteointegration to both the ilium and ischium had evidence of a healed discontinuity. The mean Harris Hip Score improved from 43 preoperatively to 77 postoperatively (P < .0001). The most common complication was a partial sciatic nerve palsy that occurred in 4 patients. Conclusion: In this series utilizing pelvic distraction, there was excellent 2-year survivorship free from revision for aseptic loosening. Despite several discontinuities persisting, 90% of patients had radiographic evidence of implant osteointegration, and clinical outcomes improved significantly. The most common complication was a partial sciatic nerve palsy. Level of Evidence: IV Case Series.
KW - acetabular bone loss
KW - chronic pelvic discontinuity
KW - distraction
KW - pelvic discontinuity
KW - revision total hip arthroplasty
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U2 - 10.1016/j.arth.2020.05.048
DO - 10.1016/j.arth.2020.05.048
M3 - Article
C2 - 32553514
AN - SCOPUS:85086476466
SN - 0883-5403
VL - 35
SP - 2966
EP - 2971
JO - Journal of Arthroplasty
JF - Journal of Arthroplasty
IS - 10
ER -