title: Review of the outcomes of complex acetabular reconstructions using a stemmed acetabular pedestal component.
abstract: OBJECTIVE
  Until now, there has been no consensus as to whether stemmed acetabular components are appropriate for use in patients undergoing revision total hip arthroplasty (THA) who have major acetabular defects or pelvic discontinuity. We wished to address this deficiency in the literature.
  
  
  METHODS
  We carried out a retrospective study of 35 patients (six men and 29 women) with a mean age of 68 years (37 to 87), with major acetabular defects who underwent revision THA between 2000 and 2012.
  
  
  RESULTS
  At a mean follow-up of 63 months (24 to 141), a total of 15 patients (43%) had required at least one further operation. Six implants (17%) loosened aseptically, four (11%) were further revised for infection and two (6%) for technical failure. By taking revision for any reason as the endpoint, the rate of survival of the implant was 61% after five years; by taking revision for aseptic loosening as the end point, it was 78%. The cumulative five-year survival for aseptic loosening was 94% in patients without pelvic discontinuity, and 56% in those with pelvic discontinuity.
  
  
  CONCLUSIONS
  These results indicate a significantly worse survival in patients with pelvic discontinuity (p = 0.020) and we advise caution in the use of the pedestal component in patients with major acetabular defects and pelvic discontinuity who require revision THA. As a result of these findings we have stopped using this implant and prefer to use particulate bone grafts protected with an anti-protrusion cage and posterior column plate fixation, if necessary.
  
  
  CONCLUSIONS
  Based on these poor results, we advise caution if using the pedestal component in patients with major acetabular defects with the presence of a pelvic discontinuity. Cite this article: Bone Joint J 2016;98-B:772-9.
authors.affiliation: Vienna General Hospital Medical University of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Stihsen
authors.affiliation: Vienna General Hospital Medical University of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria.
authors.forename: C
authors.initials: C
authors.lastname: Hipfl
authors.affiliation: Vienna General Hospital Medical University of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria.
authors.forename: B
authors.initials: B
authors.lastname: Kubista
authors.affiliation: Vienna General Hospital Medical University of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria.
authors.forename: P T
authors.initials: PT
authors.lastname: Funovics
authors.affiliation: Vienna General Hospital Medical University of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Dominkus
authors.affiliation: Vienna General Hospital Medical University of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Giurea
authors.affiliation: Vienna General Hospital Medical University of Vienna, Waehringer Gürtel 18-20, 1190 Wien, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Windhager
mesh_terms: D000077:Acetabulum / Q000000981:diagnostic imaging / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D012189:Retrospective Studies
keywords: pedestal component; pelvic discontinuity; revision hip arthroplasty