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Surgical Treatment of Pelvic Discontinuity

A Systematic Review and Meta-Analysis

Szczepanski, Jason R. BPhysio(Hons), MChD1; Perriman, Diana M. BAppSci(Phty), MSc, PhD1,2; Smith, Paul N. BMBS, FRACS(Ortho)1,2

doi: 10.2106/JBJS.RVW.18.00176
Evidence-Based Systematic Reviews
Supplementary Content

Background: Pelvic discontinuity is a rare condition that is treated with a range of implant constructs. However, surgical failure rates are high, and outcome data are inconsistent. It is therefore difficult to gain a clear picture of whether recently developed constructs (antiprotrusio cage [APC], cup-cage, custom triflange, and porous metal) provide better outcomes in terms of mechanical failure and complications in the short to long terms. This study investigated the failure and complication rates associated with cage constructs and porous metal technologies.

Methods: A systematic review and meta-analysis were performed according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines to evaluate the studies showing pelvic discontinuity in revision total hip arthroplasty. Data retrieved included the intervention performed, length of follow-up, mechanical failure, and other complication rates (dislocation, infection, neurological, loosening, migration). Study quality was assessed with the Methodological Index for Non-Randomized Studies (MINORS) instrument. Pooled mechanical failure and complication rates were calculated using MetaXL 5.3.

Results: None of the included 30 articles (n = 585 hips) were of high quality. The meta-analyses revealed a mechanical failure rate of 14% for all constructs combined. Custom triflange (5%) and cup-cage (7%) had the lowest mechanical failure rates compared with the commonly used APC (25%) and porous metal (12%). The overall other complication rate was 28%, with cup-cage lower at 21% compared with APC (34%) and custom triflange (28%). Long-term evidence investigating both interventions and porous metal technology is limited.

Conclusions: Mechanical failure rates for cup-cage and custom triflange were lowest. The other complication rate for cup-cage was lower than the pooled average. The study quality was limited, indicating a need for better studies and/or a registry.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia

2School of Medicine, College of Medicine, Biology & Environment, The Australian National University, Acton, Australian Capital Territory, Australia

E-mail address for J.R. Szczepanski:

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Investigation performed at the Trauma and Orthopaedic Research Unit, Department of Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia

Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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