Complications of ilioischial reconstruction rings in revision total hip arthroplasty1

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Abstract

The complications, management, and outcome of a consecutive series of 61 ilioischial reconstruction rings performed by 1 surgeon over a 15-year period are reported. Structural corticocancellous allografts were used in 48 cases. Twenty-seven cases had no complications, 9 had medical complications, and 5 had complications related to femoral revision. Other complications included 4 sciatic and 2 peroneal nerve palsies, 4 rings that lost fixation, 1 possibly loose ring, 3 fractured flanges, 3 loose cups, 7 dislocations, and 3 deep infections. Success, defined as a stable reconstruction with no further acetabular revision and bone graft incorporation, was 76%. We recommend a constrained acetabular liner to avoid dislocation in selected cases, slotting the ischial flange into bone for further ring stability and protection of the sciatic nerve.

Section snippets

Materials and methods

The hospital’s research ethics board approved this study, which comprised a consecutive series of 61 reconstruction rings (42 Burch-Schneider rings [Protek, Wintertur, Switzerland] and 19 Contour rings [Smith and Nephew Richards, Memphis, TN]) performed by the senior author between 1984 and 1999 during revision hip arthroplasty. These rings are made of commercially pure titanium (Fig. 1). The use of these rings constituted 12% of all acetabular revision surgeries during this period.

Follow-up

Sixty-one hips were identified within the period 1984 to 1999 as having a Burch-Schneider or Contour reconstruction ring (Table 1). According to the office and hospital charts, all patients had a painful THA and used canes, crutches, a walker, or a wheelchair preoperatively. Despite aggressive attempts at contacting all patients, for 6 of the 61 cases, the outcome could not be clearly delineated or clinical and radiographic follow-up was <2 years. For the remaining 55 of 61 cases, either

Discussion

The aim of the “reconstruction ring” approach is to replenish lost bone stock for future revisions, place the acetabulum at the correct anatomic position, and allow progressive weight bearing earlier, because the ring is attached directly to the pelvis, protecting the consolidating bone graft.

In this study, the use of a reconstruction ring was deemed necessary because of the loss of either very large (>50% of the dome), contained, bony defects or segmental loss of corticocancellous bone of the

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    1

    No benefits or funds were received in support of this study.

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