• Max J Friedrich, Jan Schmolders, Robert D Michel, Thomas M Randau, Matthias D Wimmer, Hendrik Kohlhof, Dieter C Wirtz, and Sascha Gravius.
• Department of Orthopaedics and Trauma Surgery, University Clinic of Bonn, Sigmund Freud Str. 25, 53127, Bonn, Germany, max.friedrich@ukb.uni-bonn.de.
• Int Orthop. 2014 Dec 1; 38 (12): 2455-61.

PurposeRevision 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.MethodsWe 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.ResultsAt 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.ConclusionTreatment of acetabular bone loss and pelvic discontinuity with a custom-made acetabular component can provide a durable solution with good clinical and radiographic results.

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