Revision Arthroplasty
Preoperative Radiographic Evaluation of Patients With Pelvic Discontinuity

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Abstract

Background

Pelvic discontinuity (PD) is a rare but devastating mechanism of failure in total hip arthroplasty. Radiographic findings have been described for the identification of PD. However, no study has specifically examined radiographic parameters and the utility of specific views in the preoperative identification of PD.

Methods

We performed a retrospective review of 133 patients who underwent acetabular revision for PD. Preoperative radiographic studies were reviewed including anteroposterior pelvis (AP; n = 133), true lateral hip (n = 132), Judet (n = 47), false profile (n = 4), and computed tomography scans (n = 14). Radiographs were read by the senior authors to identify the following parameters suggestive of PD: visible fracture line, medial migration of the inferior hemipelvis, and obturator ring asymmetry.

Results

Using only the AP view, the fracture line was visible in 116 (87%), medial migration of the inferior hemipelvis in 126 (95%), and obturator ring asymmetry in 114 (86%). A fracture line was visualized in 65 of 132 hips (49%) evaluated with laterals, 36 of 47 hips (77%) evaluated with Judet views, 3 of 4 (75%) evaluated with a false profile view, and 10 of 14 (71%) evaluated with computed tomography.

Conclusion

Preoperative evaluation with a combination of an AP pelvis radiograph, plus a true lateral radiograph of the hip, plus Judet films in combination with the criteria for discontinuity defined in this article, allowed for identification of PD in a 100% of patients.

Section snippets

Materials and Methods

Study approval was obtained by our institution’s review board. The total joint registry at our institution was used to identify all total hip arthroplasty revision cases in patients aged older than 18 years that were performed for PD from 1997 to 2011. A specific code identified the medical record numbers for all patients who had intraoperatively identified PD. Each patient’s medical record was retrieved, and the operative report was reviewed to confirm PD was present at the time of revision

Results

We identified 133 hips with intraoperatively confirmed PD. All hips had at least an AP pelvis radiograph that was obtained preoperatively. Additional views included a true lateral hip radiograph in 132 hips, Judet views in 47 hips, false profile views in 4 hips, and 14 had a preoperative CT scan.

The patient cohort included 21 male patients and 112 females. The modified AAOS [2] classification consisted of 4 patients with type IVA, 126 patients with type IVB, and 3 patients with type IVC

Discussion

PD remains a difficult reconstructive problem [6]. The challenges include gaining stable acetabular component fixation in the presence of a PD and achieving healing of the pelvis in the presence of bone loss. Special complex reconstructive methods typically are needed for successful management; therefore, it is desirable to identify patients with PD before surgery.

PD may be difficult to detect on radiographs for several reasons. Frequently metal (either an acetabular component or internal

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One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2015.11.024.

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