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.
A 90-year-old woman presented with a failed acetabular component and superior segmental bone loss ( Fig. 55.2 ).
This chapter describes the appropriate treatment of segmental and column defects.
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.
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.
Careful inspection is necessary to identify a pelvic discontinuity.
Success depends on adequate bony contact and firm initial fixation.