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Pelvic Discontinuity Associated With Total Hip Arthroplasty: Evaluation and Management

Abdel, Matthew P. MD; Trousdale, Robert T. MD; Berry, Daniel J. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: May 2017 - Volume 25 - Issue 5 - p 330–338
doi: 10.5435/JAAOS-D-15-00260
Review Article

Pelvic discontinuity is a challenging complication encountered during revision total hip arthroplasty. Pelvic discontinuity is defined as a separation of the ilium superiorly from the ischiopubic segment inferiorly and is typically a chronic condition in failed total hip arthroplasties in the setting of bone loss. After a history and a physical examination have been completed and infection has been ruled out, appropriate imaging must be obtained, including plain hip radiographs, oblique Judet radiographs, and often a CT scan. The main management options are a hemispheric acetabular component with posterior column plating, a cup-cage construct, pelvic distraction, and a custom triflange construct. The techniques have unique pros and cons, but the goals are to obtain stable and durable acetabular component fixation and a healed or unitized pelvis while minimizing complications.

From the Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Dr. Abdel or an immediate family member serves as a paid consultant to Stryker and serves as a board member, owner, officer, or committee member of the American Association of Hip and Knee Surgeons, the Mid-America Orthopaedic Society, the Minnesota Orthopaedic Society, and the International Congress for Joint Reconstruction. Dr. Trousdale or an immediate family member has received royalties from and serves as a paid consultant to DePuy Synthes and serves as a board member, owner, officer, or committee member of the American Association of Hip and Knee Surgeons, The Hip Society, and The Knee Society. Dr. Berry or an immediate family member has received royalties from, serves as a paid consultant to, and has received research or institutional support from DePuy Synthes, and serves as a board member, owner, officer, or committee member of the American Joint Replacement Registry, The Hip Society, and the Mayo Clinic Board of Governors.

Received May 18, 2015

Accepted April 09, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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