The treatment of pelvic discontinuity during acetabular revision

Pelvic discontinuity is frequently encountered during acetabular revision in patients with severe acetabular bone loss. Prompt recognition of the discontinuity and appropriate intraoperative management are essential for a successful clinical outcome. The treatment of the discontinuity is dependent upon the remaining host bone, the potential for healing of the discontinuity, and the potential for biologic ingrowth of acetabular components. If healing potential of the discontinuity exists, the discontinuity should be treated in compression with a posterior column plate and structural allograft or with the use of trabecular metal acting as an internal plate. If healing potential for the discontinuity does not exist, the discontinuity can be bridged and treated in distraction with either an acetabular transplant supported with a cage or with the use of a custom Triflange implant. However, the poor clinical results observed with either of these treatment modalities for a type IIIB defect with an associated pelvic discontinuity have prompted the senior author to explore the use of a trabecular metal acetabular component with 1 or 2 augments in the majority of his current type IIIB cases. The long-term clinical results of this treatment remain unknown.