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.




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.


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

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