Pelvic Discontinuity Associated With Total Hip Arthroplasty

Evaluation and Management

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

Disclosures

J Am Acad Orthop Surg. 2017;25(5):330-338. 

In This Article

Complications

Complication rates of 25% to 80% have been reported after the surgical management of pelvic discontinuity.[23,26] The most frequent complications are those traditionally associated with revision THAs, namely dislocation, infection, and nerve injury. Dislocation has occurred in up to 40% of cases, attributable to numerous previous surgeries with extensile approaches and the presence of abductor weakness.[17] Although the use of constrained liners can be considered in patients with severe abductor insufficiency, the loads placed across the bone-implant interface also must be considered in patients with compromised bone. The risk of dislocation may be mitigated with the use of large ceramic femoral heads (ie, 36 or 40 mm). However, when a femoral component is retained, a titanium sleeve should also be placed on the used trunnion. Deep periprosthetic infections are also a concern, with reported rates of up to 30%.[17] These infections are likely related to increased surgical time, devascularized tissue, multiple previous surgeries, and host status. Sciatic nerve injuries are a potentially devastating complication. Sciatic nerve injury is a particular risk during ischial dissection when the ischial flange of a cage is positioned, but it can occur as a result of retractor placement, excessive limb lengthening, or extensive soft-tissue dissection.

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