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Bispherical Metal Augment-enabled Controllable Acetabular Distraction for Chronic Pelvic Discontinuity: Mid-term
Guoyuan Li1, Yuhang Wang1, Zhengliang Luo1
1Department of Orthopedics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, People's Republic of China.
Background:
The acetabular distraction technique utilizing porous shells and augments is effective for chronic pelvic discontinuity. We report a modified technique employing a novel bispherical augment to achieve controllable distraction and enhanced reconstruction.
Methods:
We conducted a retrospective case series of 15 consecutive revision total hip arthroplasties performed for the treatment of chronic pelvic discontinuity at a single institution between 2017 and 2021. A modular revision system of bispherical augment with a highly porous hemispherical shell was used for defect reconstruction and acetabular distraction. The mean follow-up was 5.4 years (4.0-8.1 years). Primary outcomes were implant survivorship free from aseptic loosening and radiographic healing of the discontinuity were assessed, and complications were documented.
Results:
One patient (6.7%) required acetabular revision for aseptic loosening at 3.5 years. One patient required bearing exchange for recurrent dislocation at 3 months postoperatively. Radiographic healing of the discontinuity was achieved in 93.3% (14/15) of hips. One asymptomatic patient had a nonprogressive radiolucent line. Mean Harris scores improved significantly from 28.6 preoperatively to 76.3 at latest follow-up (P = .002). The hip center of rotation was significantly restored inferiorly (41.5 mm-24.4 mm, P = .003) and lower limb discrepancy corrected (24 mm-5 mm, P = .012). Cumulative survival free from revision for aseptic loosening was 90.9% (95% confidence interval: 74%-100%) at mean 5.4 years. No neurovascular complications occurred.
Conclusions:
The application of a bispherical augment to enable a modified, controllable acetabular distraction technique provides a reliable alternative method for reconstructing chronic pelvic discontinuity; further larger cohorts and longer follow-up are needed.
