Darwin Chen, MD

Pelvic Discontinuity

 

This is a 68 year old female who fell and sustained a displaced femoral neck fracture. She underwent total hip arthroplasty by another surgeon at an outside institution. Intraoperatively, there was a small fracture during acetabular shell insertion and she was made limited weight bearing after surgery. She was lost to follow up and presented back to the original surgeon with a sudden inability to walk. X-rays demonstrated a pelvic discontinuity (where the upper and lower halves of the pelvis are no longer contiguous).

 

The patient was referred to Dr. Chen for definitive management due to the extensive case complexity and his experience in difficult revision hip replacement surgery. Judet views were obtained demonstrating the disruption of the anterior and posterior columns, confirming the presence of a pelvic discontinuity.

The patient underwent revision THA using the “cup-cage” technique. The severe acetabular bone loss was addressed using porous tantalum augments. The discontinuity was spanned using a highly porous tantalum revision shell, and an acetabular cage was used as an antiprotrusio device to protect the construct.

 

At one year from surgery, the patient is able to walk without a cane for short distances and has minimal pain.

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