Management of Segmental and Column Defects





CASE STUDIES


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.




FIGURE 55.1


A, A 54-year-old patient underwent repeat surgery immediately after a failed attempt at implantation of a bilobed acetabular component. B, The patient had a pelvic discontinuity in addition to the medial wall defect.


Case 2


A 90-year-old woman presented with a failed acetabular component and superior segmental bone loss ( Fig. 55.2 ).




FIGURE 55.2


A, Anteroposterior radiograph of a 90-year-old woman with a failed acetabular component and substantial bone loss. B, Intraoperative photograph of the defect. C, Reaming of the acetabulum. D and E, Trialing with the acetabular component and an augment. F, The augment before placement of the acetabular component. G, Postoperative anteroposterior radiograph.




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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.


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May 29, 2019 | Posted by in ORTHOPEDIC | Comments Off on Management of Segmental and Column Defects
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