Acetabular distraction technique for chronic pelvic discontinuity

Background

Acetabular bone loss with an associated chronic pelvic discontinuity presents an extremely challenging problem in the setting of revision total hip arthroplasty (THA). A chronic pelvic discontinuity should be thought of as a chronic fibrous non-union and may exhibit an inability to heal, thus adding an additional layer of complexity to this clinical entity. When planning for biologic fixation, clinical success is predicated on the biology of the residual acetabular bone stock and achieving stable fixation of a cementless construct, creating a bridge effect across the superior and inferior hemipelvis, and healing of the chronic pelvic discontinuity.

Other available cementless options (e.g., cages, rings, cup-cages, custom triflange acetabular components, and 3D printed custom acetabular components) have specific inherent risks and may be associated with significant time delays and excessive costs when relying upon custom implants. In response to the difficulties seen with these alternative treatment options, the acetabular distraction technique with the use of a highly porous revision acetabular component with or without porous modular augments was introduced by Sporer and Paprosky. Premise: This technique is based on the use of a distractor placed in an extra-acetabular position to allow for peripheral or lateral distraction and resultant central or medial compression across the chronic pelvic discontinuity. ^{, , ,}

Surgical technique

Required equipment

Acetabular distraction is performed with an off-the-shelf, highly porous revision acetabular shell, with or without modular porous metal augments. When positioned properly, an acetabular distractor allows for peripheral distraction and central compression ( Fig. 22.1 ). The authors recommend performing this technique on a radiolucent Jackson table with fluoroscopic guidance.