Custom 3D-printed acetabular component for chronic pelvic discontinuity

Background

Chronic pelvic discontinuity (CPD) is the separation of the ilium superiorly from the inferior pelvis, i.e., the ischiopubic segment. While CPD most frequently stems from a chronic non-united pelvic stress fracture via deficient bone in revision total hip arthroplasty (THA), an acetabular fracture that has not healed or an acute acetabular fracture in the setting of THA may also result in a CPD.

Revision surgeries following THA are especially challenging in the presence of diffuse bone loss and major acetabular bone defects. The treatment plan for CPD is highly complex and requires vast experience, particularly in high-risk patient groups (females, those with rheumatoid arthritis, and a history of pelvic irradiation). ^, The number of cases with severe acetabular defect and an associated CPD has been rising because of the ever-increasing number of revision THAs performed. Today, CPD cases constitute 1% to 5% of challenging revisions, ^{, ,} and the potential for poor recovery still remains to be addressed in this patient population. The proper treatment strategy involves the provision of a stable continuity between the ischium and ilium as well as the restoration of the anatomical hip center.

Advances in implant technology have provided new solutions in revision THA, thereby improving patients’ quality of life. However, the surgical failure rate is high, and outcomes are inconsistent in patients with CPD undergoing THA. ^, Therefore, clear short- and long-term outcomes of revision antiprotrusio cage, cup-cage, custom triflange, and porous metals, which are frequently used today in the treatment of CPD, in terms of mechanical failure and complications, are not readily available. In contrast, it should be noted that there are three key factors that play a role in obtaining a successful outcome in the treatment of CPD, i.e., the remaining bone stock, biologic in-growth potential, and healing potential of the discontinuity.

Three-dimensional (3D) printing technology, which has been shown to provide a significant contribution to anatomic-biologic healing, has already been integrated into surgical practice. ^, This chapter provides detailed information on the use of custom 3D printed acetabular components in patients with CPD. Premise: The use of 3D technology is used to provide tailored solutions to each patient with severe acetabular bone loss and an associated CPD. ^,

Surgical technique