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Management of Pelvic Discontinuity With Antiprotrusio Cage

Nov. 16, 2020


■ Expose the failed acetabular component circumferentially.

■ Remove the component, and débride cement and membrane from the remaining acetabulum with curets, osteotomes, and hemispherical reamers to achieve a wellvascularized bed.

■ Morselize cancellous allograft bone into 1-cm 3 chips; press the cancellous chips into the cavity, and condense them into a hemispherical shape.

■ Bend the flanges of the antiprotrusio cage to fit into a slot in the ischium and against the host ilium. Fix the ring to the ilium and ischium with screws.

■ Cement an all-polyethylene socket into place with a 2- to 3-mm cement mantle. 

In rare instances, the acetabulum is so deficient that an allograft of an entire acetabulum is the only option. Garbuz et al. found that 45% of massive acetabular allograft revisions required revision at minimum 5-year follow-up. Their best results were obtained when the allograft was augmented with an acetabular reinforcement ring. DeBoer et al. reviewed 20 hips in 18 patients with pelvic discontinuity treated with a custom, triflanged component (Fig. 3-164). At average 10-yearfollow-up, no components were revised and none was radiographically loose. Dislocation was the most common complication, occurring in five hips. Procedures of this degree of complexity are best referred to a major center with surgeons skilled in revision surgery.


Note: this article comes from CAMPBELL'S OPERATIVE ORTHOPAEDICS by S. Terry Canale James H. Beaty.