Case 1
A 54-year-old male had a failed attempt of an acetabular reconstruction with a bilobed component ( Fig.55.1 ). He was found to have a large posterior column defect and a pelvic dissociation. A cage reconstruction with bone grafting was used to bridge the discontinuity.
Case 2
A 90-year-old woman presented with a failed acetabular component and superior segmental bone loss ( Fig. 55.2 ).
Chapter Preview
Chapter Synopsis
This chapter describes the appropriate treatment of segmental and column defects.
Important Points
- •
Segmental defects involve the acetabular rim and compromise structural integrity.
- •
Column defects are the most difficult to manage and involve loss of the anterior and posterior columnar supporting structures.
- •
Treatment depends on the location and extent of the defect and the supporting host bone.
Clinical/Surgical Pearls
- •
Most segmental deficiencies can be treated with a hemispherical component when 40% to 50% contact with host bone is possible
- •
Bone grafting and augments may be necessary.
- •
Significant column defects may require large sturctural allografts and/or cage support.
- •
The surgeon must identify the location of the lesion, assess both columns to determine whether there is a discontinuity, reestablish the hip center, and obtain secure initial fixation.
Clinical/Surgical Pitfalls
- •
Careful inspection is necessary to identify a pelvic discontinuity.
- •
Success depends on adequate bony contact and firm initial fixation.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
