Augmenting Pathologic Acetabular Bone Loss With Photodynamic Nails to Support Primary Total Hip Arthroplasty

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Reconstructive Surgery

Background:

• Pathologic acetabular defects compromise primary total hip arthroplasty (THA) stability and osseointegration.
• Photodynamic nails (PDNs) offer a modified Harrington technique for space-filling stability.
• PDN augmentation aims to enhance implant stability without hindering osseointegration.

Purpose of the Study:

• To describe the experience with PDN-augmented THAs in managing severe acetabular defects.
• To evaluate implant survivorship and pain reduction in patients receiving PDN-augmented THA.
• To assess the efficacy of PDN augmentation in complex acetabular reconstructions.

Main Methods:

• Retrospective analysis of patients undergoing PDN-augmented THA for severe acetabular defects (Harrington class II or III).
• Inclusion criteria: minimum 6-month follow-up.
• Primary outcome: implant survivorship. Secondary outcome: pain score improvement (visual analogue scale).

Main Results:

• Six patients included (5 metastatic cancer, 1 pelvic discontinuity/avascular necrosis).
• Mean follow-up: 10.3 months. Mean age: 75.5 years. Most patients were ASA class III.
• Significant pain score improvement (7.8 to 2.0, P=.008). Two revisions were required.

Conclusions:

• PDN augmentation of periacetabular bone effectively manages large pelvic defects.
• The technique provides durable pain relief and functional improvement in high-risk patients.
• PDN augmentation is a valuable tool for reconstructive surgeons facing complex acetabular defects.