Pelvic discontinuity: a challenge to overcome.

Area of Science:

• Orthopedic Surgery
• Arthroplasty
• Reconstructive Surgery

Background:

• Pelvic discontinuity (PD) is a significant complication in hip revision arthroplasty.
• PD can manifest as acute fractures or chronic bone loss, complicating acetabular reconstruction.
• Historically, treatment options like ORIF, cages, and bone grafts had limited success.

Purpose of the Study:

• To review the current understanding and management strategies for pelvic discontinuity in hip revision surgery.
• To highlight advancements in diagnostic tools, implants, and surgical techniques for PD.

Main Methods:

• Review of current literature and established surgical techniques for managing pelvic discontinuity.
• Discussion of novel implants such as ultraporous cups, augments, cup-cage constructs, and custom triflange components.
• Emphasis on the combination of surgical reconstruction with ORIF and bone grafting.

Main Results:

• Modern surgical armamentarium, including ultraporous implants and cup-cage constructs, has revolutionized PD treatment.
• Cup-cage constructs demonstrate good medium-term results for chronic PD.
• Dislocation and infection remain primary causes of failure.

Conclusions:

• Hip revision surgeons now possess a comprehensive toolkit to address pelvic discontinuity effectively.
• Individualized treatment strategies, incorporating surgeon experience and improvisation, are crucial for optimal outcomes.