Acetabular Distraction Technique: A Multicenter Study With a Minimum 2-Year Radiographic Follow-Up

Christopher M Melnic; Mehdi S Salimy; Gregory T Minutillo; Acetabular Distraction Revision Arthroplasty Consortium; Wayne G Paprosky; Neil P Sheth

doi:10.1016/j.arth.2024.02.036

Acetabular Distraction Technique: A Multicenter Study With a Minimum 2-Year Radiographic Follow-Up

J Arthroplasty. 2024 Feb 23:S0883-5403(24)00135-9. doi: 10.1016/j.arth.2024.02.036. Online ahead of print.

Authors

Christopher M Melnic¹, Mehdi S Salimy², Gregory T Minutillo³; Acetabular Distraction Revision Arthroplasty Consortium; Wayne G Paprosky⁴, Neil P Sheth³

Collaborators

Acetabular Distraction Revision Arthroplasty Consortium:
Sabrina F Schundler, Robert A Burnett 3rd, Colin M Baker, P Maxwell Courtney, Hany S Bedair, Scott M Sporer

Affiliations

¹ Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Orthopaedic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts.
² Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
³ Department of Orthopaedic Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania.
⁴ Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.

PMID: 38401613
DOI: 10.1016/j.arth.2024.02.036

Abstract

Background: Chronic pelvic discontinuity is a challenge during revision total hip arthroplasty due to the loss of structural continuity of the superior and inferior aspects of the acetabulum from severe acetabular bone loss. Acetabular distraction provides an alternative surgical treatment by stabilizing the acetabular component through elastic recoil of the pelvis, which may be supplemented with modular porous augments for addressing major acetabular defects. This study reports 2-year radiographic findings following acetabular distraction for the treatment of chronic pelvic discontinuity.

Methods: Patients undergoing acetabular distraction performed by 5 surgeons from 2002 to 2021 were identified across 5 institutions. Demographic, surgical, and postoperative outcomes, including radiographic component stability, were recorded. There were 53 of 91 (58.2%) patients (5 deceased, 33 lost to follow-up) consisting of 4 Paprosky IIC (7.5%), 8 Paprosky IIIA (15.1%), and 41 Paprosky IIIB (77.4%) defects included, with a mean follow-up time of 4.8 years (range, 2 to 13.5). Modular porous augments were used in 33 (62.3%) cases. Failure was defined as a subsequent revision of the acetabular construct.

Results: Among the 13 (24.5%) patients who returned to the operating room, 6 (46.2%) had a prior history of revision total hip arthroplasty before undergoing acetabular distraction. Only 5 (9.4%) patients underwent acetabular revision following acetabular distraction, leading to an overall cup survivorship of 90.6%. Of the remaining 48 patients, 46 (95.8%) had evidence of radiographic bridging callus of the chronic pelvic discontinuity at their last clinical follow-up.

Conclusions: To our knowledge, in the largest series to date, acetabular distraction has proven to be a viable treatment for acetabular bone loss with a chronic pelvic discontinuity, with excellent early survivorship and radiographic evidence of bridging callus. Future studies with longer follow-ups are needed to further monitor the efficacy of this technique.

Level of evidence: Level III, Retrospective Comparative Study.

Keywords: acetabular distraction; chronic pelvic discontinuity; modular porous augments; radiographic outcomes; revision total hip arthroplasty; surgical technique.