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Management of Segmental and Column Defects


CASE STUDIES

Case 1

A 54-year-old male had a failed attempt of an acetabular reconstruction with a bilobed component ( Fig.55.1 ). He was found to have a large posterior column defect and a pelvic dissociation. A cage reconstruction with bone grafting was used to bridge the discontinuity.

FIGURE 55.1, A, A 54-year-old patient underwent repeat surgery immediately after a failed attempt at implantation of a bilobed acetabular component. B, The patient had a pelvic discontinuity in addition to the medial wall defect.

Case 2

A 90-year-old woman presented with a failed acetabular component and superior segmental bone loss ( Fig. 55.2 ).

FIGURE 55.2, A, Anteroposterior radiograph of a 90-year-old woman with a failed acetabular component and substantial bone loss. B, Intraoperative photograph of the defect. C, Reaming of the acetabulum. D and E, Trialing with the acetabular component and an augment. F, The augment before placement of the acetabular component. G, Postoperative anteroposterior radiograph.

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Chapter Synopsis

This chapter describes the appropriate treatment of segmental and column defects.

Important Points

  • Segmental defects involve the acetabular rim and compromise structural integrity.

  • Column defects are the most difficult to manage and involve loss of the anterior and posterior columnar supporting structures.

  • Treatment depends on the location and extent of the defect and the supporting host bone.

Clinical/Surgical Pearls

  • Most segmental deficiencies can be treated with a hemispherical component when 40% to 50% contact with host bone is possible

  • Bone grafting and augments may be necessary.

  • Significant column defects may require large sturctural allografts and/or cage support.

  • The surgeon must identify the location of the lesion, assess both columns to determine whether there is a discontinuity, reestablish the hip center, and obtain secure initial fixation.

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