Management of chronic pelvic discontinuity during revision hip arthroplasty using the 'acetabular distraction technique' : clinical and radiological outcomes from a two-centre study with a minimum two-year follow-up.

Abstract

Aims: Chronic pelvic discontinuity (CPD) during revision hip arthroplasty is a challenging entity to address. The aim of this study was to evaluate the clinical and radiological outcomes and complications of the 'acetabular distraction technique' for the management of CPD during revision hip arthroplasty.

Methods: Patients with CPD, who underwent acetabular revision between January 2014 and April 2022 at two tertiary care centres, using an identical distraction technique, were evaluated. Demographic parameters, preoperative acetabular bone loss, duration of follow-up, clinical and radiological outcomes, and survivorship were evaluated.

Results: In all, 46 patients with a mean follow-up of 34.4 months (24 to 120) were available for evaluation. There were 25 male (54.3%) and 21 female (45.7%) patients, with a mean age of 58.1 years (40 to 81) at the time of revision surgery. Based on the Paprosky classification for acetabular bone loss, 19 (41.3%), 12 (26.1%), and 15 (32.6%) patients had type IIIB, IIIA, and IIC defects, respectively. All patients were managed using the Trabecular Metal Acetabular Revision System; 16 patients required additional Trabecular Metal augments. The mean Harris Hip Score improved from 50.1 (34.3 to 59.8) preoperatively to 86.6 (74.8 to 91.8) at the last follow-up (p < 0.001). Of the 46 patients studied, 34 were able to walk unaided, whereas 12 required a walking stick. Two patients (4.3 %) developed partial sciatic nerve palsy, two (4.3%) had posterior dislocation, and one (2.2%) required re-revision for aseptic loosening. Radiologically, 36 patients (78.3%) showed healing of the pelvic discontinuity through bony bridging. The overall cup survivorship was 97.8%, while the three-year survivorship free from any re-revision was 94.1% based on a Kaplan-Meier survival plot.

Conclusion: The acetabular distraction technique results in good clinical and radiological outcomes in the management of CPD during revision hip arthroplasty.