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High hip center bipolar hemiarthroplasty for non-reconstructable pelvic discontinuity.

Chalidis BE, Ries MD - Acta Orthop (2009)

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA. byronchalidis@gmail.com

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A 79-year-old woman with bilateral lower extremity weakness due to cervical myelopathy presented at our department in 2002 after multiple reconstructive procedures in both hips for developmental dysplasia of the hip... In 2002, a high hip center bipolar hemiarthroplasty was performed via a standard posterior hip approach... Failed acetabular component and hardware were removed but the femoral stem was left in situ as it was found to be stable... A 60-mm bipolar femoral head was inserted onto the femoral component to articulate with the periacetabular soft tissues in a high hip center mode... Due to complete loss of lower extremity motor function associated with failed spine surgery and cervical myelopathy, the patient was non-ambulatory... However, the outcome of the technique as a definitive procedure was considered to be poor due to motion between the outer bipolar surface and bone, which led to progressive bone loss and component migration... Eventually, the method was abandoned although it was considered superior to excision arthroplasty... We have used the bipolar femoral head to articulate with the periacetabular soft tissues as an alternative to excision arthroplasty in patients with non-reconstructable acetabular discontinuity... Apart from pain, functional results are also unclear and highly variable in the literature, as patient satisfaction has ranged from 14% to 100%... In the cases presented here, the bipolar component does not articulate with the pelvis and weight-bearing forces would not be expected to be transmitted through the acetabular defect... The inability to achieve weight-bearing capacity is most likely related to the lack of mechanical support for transferring loads from the hip to the axial skeleton... Since significant neurological, medical, or other orthopedic impairments had already compromised the mobility of our patients, the limited hip function associated with a chronically dislocated and migrated bipolar prosthesis does not appear to have affected their activity level further... Ultimately, the final outcome was characterized by pain relief, improvement in sitting ability, and high level of satisfaction—as demonstrated by the first patient who underwent a high hip center bipolar hemiarthroplasty and elected to have the same operation performed on her contralateral hip... We believe that this technique is a reasonable alternative to excision arthroplasty for sedentary and low-demand patients with non-reconstructable pelvic discontinuity.

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Patient 1. A. Bilateral pelvic discontinuity after failed treatment with structural allografting and cage fixation (left hip) and bone grafting with Girdlestone arthroplasty (right hip). B. Both hips were converted to bipolar hemiarthroplasty after several unsuccessful surgical attempts. No effort was made to further stabilize or reconstruct the bilateral pelvic discontinuities.
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Figure 0001: Patient 1. A. Bilateral pelvic discontinuity after failed treatment with structural allografting and cage fixation (left hip) and bone grafting with Girdlestone arthroplasty (right hip). B. Both hips were converted to bipolar hemiarthroplasty after several unsuccessful surgical attempts. No effort was made to further stabilize or reconstruct the bilateral pelvic discontinuities.

Mentions: A 79-year-old woman with bilateral lower extremity weakness due to cervical myelopathy presented at our department in 2002 after multiple reconstructive procedures in both hips for developmental dysplasia of the hip. In 1993, a bulk allograft in combination with an acetabular cage and a cemented cup were used to treat the left massive acetabular bone loss. The defect was type IVb by the classification of the American Academy of Orthopaedic Surgeons (D'Antonio et al. 1989) and Berry et al. (1999). In 2000, the acetabular construct failed mechanically while the existing cemented femoral stem remained well fixed (Figure 1A). Removal of the acetabular hardware was followed by implantation of a whole acetabular allograft. The allograft was stabilized with plates and screws, and a new cemented cup was inserted. 2 years later, allograft fracture and acetabular failure occurred again.


High hip center bipolar hemiarthroplasty for non-reconstructable pelvic discontinuity.

Chalidis BE, Ries MD - Acta Orthop (2009)

Patient 1. A. Bilateral pelvic discontinuity after failed treatment with structural allografting and cage fixation (left hip) and bone grafting with Girdlestone arthroplasty (right hip). B. Both hips were converted to bipolar hemiarthroplasty after several unsuccessful surgical attempts. No effort was made to further stabilize or reconstruct the bilateral pelvic discontinuities.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823180&req=5

Figure 0001: Patient 1. A. Bilateral pelvic discontinuity after failed treatment with structural allografting and cage fixation (left hip) and bone grafting with Girdlestone arthroplasty (right hip). B. Both hips were converted to bipolar hemiarthroplasty after several unsuccessful surgical attempts. No effort was made to further stabilize or reconstruct the bilateral pelvic discontinuities.
Mentions: A 79-year-old woman with bilateral lower extremity weakness due to cervical myelopathy presented at our department in 2002 after multiple reconstructive procedures in both hips for developmental dysplasia of the hip. In 1993, a bulk allograft in combination with an acetabular cage and a cemented cup were used to treat the left massive acetabular bone loss. The defect was type IVb by the classification of the American Academy of Orthopaedic Surgeons (D'Antonio et al. 1989) and Berry et al. (1999). In 2000, the acetabular construct failed mechanically while the existing cemented femoral stem remained well fixed (Figure 1A). Removal of the acetabular hardware was followed by implantation of a whole acetabular allograft. The allograft was stabilized with plates and screws, and a new cemented cup was inserted. 2 years later, allograft fracture and acetabular failure occurred again.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, University of California, San Francisco, CA, USA. byronchalidis@gmail.com

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

A 79-year-old woman with bilateral lower extremity weakness due to cervical myelopathy presented at our department in 2002 after multiple reconstructive procedures in both hips for developmental dysplasia of the hip... In 2002, a high hip center bipolar hemiarthroplasty was performed via a standard posterior hip approach... Failed acetabular component and hardware were removed but the femoral stem was left in situ as it was found to be stable... A 60-mm bipolar femoral head was inserted onto the femoral component to articulate with the periacetabular soft tissues in a high hip center mode... Due to complete loss of lower extremity motor function associated with failed spine surgery and cervical myelopathy, the patient was non-ambulatory... However, the outcome of the technique as a definitive procedure was considered to be poor due to motion between the outer bipolar surface and bone, which led to progressive bone loss and component migration... Eventually, the method was abandoned although it was considered superior to excision arthroplasty... We have used the bipolar femoral head to articulate with the periacetabular soft tissues as an alternative to excision arthroplasty in patients with non-reconstructable acetabular discontinuity... Apart from pain, functional results are also unclear and highly variable in the literature, as patient satisfaction has ranged from 14% to 100%... In the cases presented here, the bipolar component does not articulate with the pelvis and weight-bearing forces would not be expected to be transmitted through the acetabular defect... The inability to achieve weight-bearing capacity is most likely related to the lack of mechanical support for transferring loads from the hip to the axial skeleton... Since significant neurological, medical, or other orthopedic impairments had already compromised the mobility of our patients, the limited hip function associated with a chronically dislocated and migrated bipolar prosthesis does not appear to have affected their activity level further... Ultimately, the final outcome was characterized by pain relief, improvement in sitting ability, and high level of satisfaction—as demonstrated by the first patient who underwent a high hip center bipolar hemiarthroplasty and elected to have the same operation performed on her contralateral hip... We believe that this technique is a reasonable alternative to excision arthroplasty for sedentary and low-demand patients with non-reconstructable pelvic discontinuity.

Show MeSH