Limits...
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

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
Patient 2. A. Non-reconstructable left pelvic discontinuity after failed treatment with a cementless cup and trabecular metal augments. The femur had been reconstructed with a segmental allograft prosthetic composite. B. Removal of the acetabular component was combined with insertion of a large bipolar head on the existing femoral prosthesis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2823180&req=5

Figure 0002: Patient 2. A. Non-reconstructable left pelvic discontinuity after failed treatment with a cementless cup and trabecular metal augments. The femur had been reconstructed with a segmental allograft prosthetic composite. B. Removal of the acetabular component was combined with insertion of a large bipolar head on the existing femoral prosthesis.

Mentions: A 64-year-old woman with prior pelvic irradiation for non-Hodgkin’s lymphoma underwent total hip arthroplasty (THA) and 6 subsequent revision THAs for mechanical failure and recurrent hip dislocation. She presented with pelvic discontinuity (type IVc) pelvic osteonecrosis, and sciatic nerve palsy in 2002. This was treated using a bulk allograft fixed with posterior plating, a reinforcement ring, and a cemented cup. After 1 year, infection developed and a 2-stage revision arthroplasty was carried out. 2 years later, a periprosthetic femoral fracture occurred in association with loosening of the acetabular construct. The acetabulum was reconstructed with a composite of bulk allograft and hemispherical cementless cup supplemented with trabecular metal augments while the femoral component was revised to a total femur. Mechanical failure of the acetabular reconstruction occurred within 3 months (Figure 2A). A 70-mm diameter bipolar head was inserted onto the unrevised femoral stem and was stabilized by the soft tissues along the lateral ilium (Figure 2B).


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

Chalidis BE, Ries MD - Acta Orthop (2009)

Patient 2. A. Non-reconstructable left pelvic discontinuity after failed treatment with a cementless cup and trabecular metal augments. The femur had been reconstructed with a segmental allograft prosthetic composite. B. Removal of the acetabular component was combined with insertion of a large bipolar head on the existing femoral prosthesis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0002: Patient 2. A. Non-reconstructable left pelvic discontinuity after failed treatment with a cementless cup and trabecular metal augments. The femur had been reconstructed with a segmental allograft prosthetic composite. B. Removal of the acetabular component was combined with insertion of a large bipolar head on the existing femoral prosthesis.
Mentions: A 64-year-old woman with prior pelvic irradiation for non-Hodgkin’s lymphoma underwent total hip arthroplasty (THA) and 6 subsequent revision THAs for mechanical failure and recurrent hip dislocation. She presented with pelvic discontinuity (type IVc) pelvic osteonecrosis, and sciatic nerve palsy in 2002. This was treated using a bulk allograft fixed with posterior plating, a reinforcement ring, and a cemented cup. After 1 year, infection developed and a 2-stage revision arthroplasty was carried out. 2 years later, a periprosthetic femoral fracture occurred in association with loosening of the acetabular construct. The acetabulum was reconstructed with a composite of bulk allograft and hemispherical cementless cup supplemented with trabecular metal augments while the femoral component was revised to a total femur. Mechanical failure of the acetabular reconstruction occurred within 3 months (Figure 2A). A 70-mm diameter bipolar head was inserted onto the unrevised femoral stem and was stabilized by the soft tissues along the lateral ilium (Figure 2B).

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