[Pelvic discontinuity in revision total hip arthroplasty--case report]

Revision total hip arthroplasty with massive bone loss and pelivic discontinuity has no standardized treatment up until now. This report presents a case of a female patient with a diagnosed pelvic discontinuity 4 years after the previous hip arthroplasty. The patient is suffering from rheumatoid arthritis, and was admitted to hospital treatment for hip pain, leg shortening, limitated range of motion and the inability to walk. Pelvic discontinuity was identified in preoperative radiographs of the pelvic and hip region, and intraoperatively it was determined that it was a type IV b discontinuity according classifications for acetabular defects defined by AAOS, and subclassification of type IV according Berry et al., that is discontinuity associated with cavitary and segmental acetatabular bone loss. In the goal of achieveing a stable construction, as a vital prerequisite for achieving bone consolidation, an osteosynthesis of the posterior column was done with a reconstructive plate by A.O. method, and afterwards the defect was filed with bone transplants from the bone transplant bank. An adequate revision cementless cup was installed, and screws were used to achieve a good fixation of the bigger modeled bone transplants and the fixation of the cup for the remainder of the pelvis. By that method a good inicial stability of construction was achieved. In the goal of achieving bone ingrowth and avoidance of mechanical failure it was advised an avoidance of weight bearing in the period of 3-6 months after the operation. With the method of reconstruction we applied after 2 years of follow-up the cinical result was satisfactory, and radiologicaly there are no signs of construction loosening so it can be claimed that the discontinuity was cured.