Reconstruction of major column defects and pelvic discontinuity in revision total hip arthroplasty

Acetabular reconstruction with severe bone loss after failed total hip arth roplasty is a difficult problem. Defects were defined as major segmental an d cavitary loss (type III anterior or posterior) or pelvic discontinuity (t ype IV). Seventeen cases were treated, of which 7 were type III and 10 were type IV. Bulk allograft was used in 16 of 17 cases, of which 7 were whole acetabular grafts, 2 were posterior segmental acetabular grafts, and 7 were femoral heads. Fourteen of 17 patients were female. The extensile triradia te approach was used in 12 cases. Long pelvic bone plates were applied to t he posterior column and anterior brim of the pelvis in most cases. Allograf ts united to host-bone in 15 cases. Average follow-up was 83 months. The ov erall revision rate was 47%, of which 3 of 7 press-fit and 2 of 10 cemented cups had failed. The dislocation rate for the extensile approach was 50%; 2 patients had excisional arthroplasty for infection, and 2 patients had ex ploration of the sciatic nerve for release from migrating pelvic plate stre ws. Because of the overall poor results, this approach cannot be recommende d for general use.