Total Hip Revision Arthroplasty Techniques - Pelvic Dissociation

General points

  • Involves complete dissociation of the acetabulum from the ilium.
  • Generally look at the posterior column.
  • If the posterior column is gone, there is a dissociation.
  • If the posterior column is intact there is no dissociation.

Treatment (Walter) - Young patients

Aim here is for a ‘biological solution’ ie reconstruction of bone loss, and no cement.
It involves 2 stage surgery with a long period (many months) of TWB in interim.

Technique

1st stage – to stabilise the dissociation and fill the bone defects.

  • Posterior approach to hip and acetabulum.
  • Reduce and fix the posterior column.
  • Use pelvic reconstruction plate from ilium to ischium.
  • The anterior column does not need to be fixed – combination of stabilisation of the posterior column and impaction grafting will help it heal.
  • Impaction grafting of defects with NON-IRRADIATED allograft and mesh.
  • Leave all other prostheses out.
  • No spacers as they will load the acetabulum and slow or prevent union of the posterior column and incorporation of the bone graft.
  • 6 weeks bed rest followed by several months TWB.

    2nd stage – Re-implantation of prostheses.
  • Posterior approach.
  • Remove mesh.
  • Ream acetabulum as per normal.
  • Re-insert.

Treatment – Elderly patients

  • Approach here is more traditional.
  • Single stage procedure.
  • Elderly patients are less tolerable of prolonged immobilisation
  • Cons of non-biological solution (cement) less problematic in the elderly.
  • Posterior approach to hip and acetabulum.
  • Reduce and fix the posterior column.
  • Screw in a reconstruction cage.
  • Some reconstruction cages may simultaneously fix the posterior column.
  • Cement a cup into the cage.

Osseointegration Group of AustraliaNorwest Advanced OrthopaedicsDrummoyne Advanced Specialty ServicesThe Sports & Arthritis Clinic NorwestNorwest Advanced Specialty Services