Acetabular Distraction: Promising 5-Year Outcomes for the Treatment of Chronic Pelvic Discontinuity

Mehdi S Salimy; Gregory T Minutillo; Christopher M Melnic; Acetabular Distraction Revision Arthroplasty Consortium

doi:10.1016/j.arth.2024.04.082

Acetabular Distraction: Promising 5-Year Outcomes for the Treatment of Chronic Pelvic Discontinuity

J Arthroplasty. 2024 May 8:S0883-5403(24)00430-3. doi: 10.1016/j.arth.2024.04.082. Online ahead of print.

Authors

Mehdi S Salimy, Gregory T Minutillo, Christopher M Melnic; Acetabular Distraction Revision Arthroplasty Consortium

Collaborators

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

PMID: 38729228
DOI: 10.1016/j.arth.2024.04.082

Abstract

Background: Severe acetabular bone loss encountered during revision total hip arthroplasty (THA) poses a clinical challenge. In cases involving pelvic discontinuity, where the ilium is separated superiorly from the inferior ischiopubic segment through the acetabulum, acetabular distraction may be used to restore the biomechanics of the hemipelvis. This technique allows for correct sizing of the acetabulum, and the subsequent peripheral distraction and medial compression at the discontinuity provide initial mechanical stability and biological fixation as bone ingrowth occurs. Accordingly, this study aimed to assess long-term 5-year outcomes following acetabular distraction across two institutions.

Methods: We retrospectively identified all patients who underwent revision THA in which the acetabular distraction technique was performed for the treatment of chronic pelvic discontinuity between 2002 and 2018. Demographic, operative, and clinical post-operative data were collected. Clinical endpoints included post-operative radiographic outcomes, complications requiring additional surgery, and re-operation for all causes. Only patients who had a minimum 5-year follow-up were included in this study.

Results: A total of 15 patients (Paprosky IIC: one patient, 6.7%; Paprosky IIIA: five patients, 33.3%; Paprosky IIIB: nine patients, 60%) who had a mean follow-up time of 9 years (range, 5.1 to 13.5) were analyzed. Porous tantalum augments were used in 11 (73.3%) cases to primarily address posterior-superior defects (100%). There were four (26.7%) patients that required re-operation, only two of which were for indications related to the acetabular construct, leading to an overall survivorship of 86.7%. Both patients had a prior revision THA before the implementation of the distraction technique. Evidence of bridging callus formation was reported radiographically for 14 (93.3%) patients at the time of the last clinical follow-up.

Conclusion: For patients who have chronic pelvic discontinuity, acetabular distraction shows promising long-term outcomes. Even so, larger multicenter studies are needed to better support the efficacy of this technique.

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