title: Acetabular distraction: an alternative for severe defects with chronic pelvic discontinuity?
abstract: BACKGROUND
  Stabilization of a pelvic discontinuity with a posterior column plate with or without an associated acetabular cage sometimes results in persistent micromotion across the discontinuity with late fatigue failure and component loosening. Acetabular distraction offers an alternative technique for reconstruction in cases of severe bone loss with an associated pelvic discontinuity.
  
  
  OBJECTIVE
  We describe the acetabular distraction technique with porous tantalum components and evaluate its survival, function, and complication rate in patients undergoing revision for chronic pelvic discontinuity.
  
  
  METHODS
  Between 2002 and 2006, we treated 28 patients with a chronic pelvic discontinuity with acetabular reconstruction using acetabular distraction. A porous tantalum elliptical acetabular component was used alone or with an associated modular porous tantalum augment in all patients. Three patients died and five were lost to followup before 2 years. The remaining 20 patients were followed semiannually for a minimum of 2 years (average, 4.5 years; range, 2-7 years) with clinical (Merle d'Aubigné-Postel score) and radiographic (loosening, migration, failure) evaluation.
  
  
  RESULTS
  One of the 20 patients required rerevision for aseptic loosening. Fifteen patients remained radiographically stable at last followup. Four patients had early migration of their acetabular component but thereafter remained clinically asymptomatic and radiographically stable. At latest followup, the average improvement in the patients not requiring rerevision using the modified Merle d'Aubigné-Postel score was 6.6 (range, 3.3-9.6). There were no postoperative dislocations; however, one patient had an infection, one a vascular injury, and one a bowel injury.
  
  
  CONCLUSIONS
  Acetabular distraction with porous tantalum components provides predictable pain relief and durability at 2- to 7-year followup when reconstructing severe acetabular defects with an associated pelvic discontinuity.
  
  
  METHODS
  Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL 60612, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Sporer
authors.forename: John J
authors.initials: JJ
authors.lastname: Bottros
authors.forename: Jonah B
authors.initials: JB
authors.lastname: Hulst
authors.forename: Vamsi K
authors.initials: VK
authors.lastname: Kancherla
authors.forename: Mario
authors.initials: M
authors.lastname: Moric
authors.forename: Wayne G
authors.initials: WG
authors.lastname: Paprosky
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D019644:Arthroplasty, Replacement, Hip; D001672:Biocompatible Materials; D001862:Bone Resorption / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006621:Hip Joint / Q000601:surgery*; D006801:Humans; D007592:Joint Diseases / Q000601:surgery*; D008297:Male; D010384:Pelvic Bones / Q000601:surgery*; D011475:Prosthesis Failure; D012086:Reoperation; D013635:Tantalum
chemical_list: D001672:Biocompatible Materials; D013635:Tantalum