title: Management of severe periacetabular bone loss combined with pelvic discontinuity in revision hip arthroplasty.
abstract: OBJECTIVE
  Revision of failed total hip arthroplasty with massive acetabular bone loss resulting in pelvic discontinuity represents a rare but challenging problem. The objective of this study was to present short to mid-term results of revision total hip arthroplasty with a custom-made acetabular implant in a consecutive series of patients with pelvic discontinuity.
  
  
  METHODS
  We retrospectively reviewed 18 consecutive patients with massive acetabular bone loss (Paprosky Type 3B) resulting in pelvic discontinuity reconstructed with revision total hip arthroplasty using a custom-made acetabular component. The prosthesis was created on the basis of a thin-cut 1-mm computed tomography (CT) scan of the pelvis. Initial stability of the implant was obtained by screw fixation. Harris hip score and sequential radiographs were used to evaluate the clinical and radiographic results.
  
  
  RESULTS
  At an average follow up of 30 months (range 17-62 months) 16 of 18 (88.9%) custom-made implants were considered radiographically stable without signs of acetabular migration of more than 2 mm in the horizontal or vertical direction, implant rotation or screw breakage. Complications included two periprosthetic joint infections treated with explantation of the implant. Three patients had recurrent dislocations postoperatively. The mean Harris hip score improved from 28 ± 12 points preoperatively to 69 ± 13 points at the time of last follow up.
  
  
  CONCLUSIONS
  Treatment of acetabular bone loss and pelvic discontinuity with a custom-made acetabular component can provide a durable solution with good clinical and radiographic results.
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University Clinic of Bonn, Sigmund Freud Str. 25, 53127, Bonn, Germany, max.friedrich@ukb.uni-bonn.de.
authors.forename: Max J
authors.initials: MJ
authors.lastname: Friedrich
authors.forename: Jan
authors.initials: J
authors.lastname: Schmolders
authors.forename: Robert D
authors.initials: RD
authors.lastname: Michel
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Randau
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Wimmer
authors.forename: Hendrik
authors.initials: H
authors.lastname: Kohlhof
authors.forename: Dieter C
authors.initials: DC
authors.lastname: Wirtz
authors.forename: Sascha
authors.initials: S
authors.lastname: Gravius
mesh_terms: D000077:Acetabulum / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D001862:Bone Resorption / Q000601:surgery*; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012399:Rotation; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome