Treatment of Acetabular Bone Loss and Chronic Pelvic Discontinuity

1st Edition - January 22, 2023
Authors: Neil P. Sheth, Wayne Paprosky
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 8 7 5 5 0 - 9
eBook ISBN:
9 7 8 - 0 - 3 2 3 - 8 7 5 5 1 - 6

Edited and written by pioneers and experts in the field, Treatment of Acetabular Bone Loss and Chronic Pelvic Discontinuity is the first text to provide focused, practical content… Read more

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Edited and written by pioneers and experts in the field, Treatment of Acetabular Bone Loss and Chronic Pelvic Discontinuity is the first text to provide focused, practical content on the effective evaluation and treatment of this challenging problem. Comprehensive and easy to follow, it offers a step-by-step approach to teach surgeons how to tailor their surgery to each individual patient’s anatomy with the goal of improving patient outcomes.

Cover image
Title page
Table of Contents
Copyright
Dedication
Foreword
Preface
List of contributors
Video contents
List of Tables
List of Illustrations
1. Introduction
2. Acetabular bone loss classification
Introduction
Alternative classification systems
Paprosky classification system
Summary
Editorial comment
References
3. Radiographic evaluation of severe acetabular bone loss +/– chronic pelvic discontinuity
Background
Radiographic classification of acetabular bone loss (please see Chapter 2 for further detail)
Summary
References
4. Cementless acetabular revision (type I defects)
Background
Surgical technique
Common pitfalls and tendencies
Postoperative protocol and common complications
Summary of clinical outcomes
Illustrative case
Editorial comment
References
5. Cemented revision in type I defects
Background
Surgical technique
Common pitfalls and tendencies
Postoperative protocol and common complications
Summary of clinical outcomes
Illustrative case
Editorial comment
References
6. Cementless acetabular revision for the distorted acetabulum with intact columns (type IIA, B, and C defects)
Background
Preoperative planning
Patient positioning and surgical approach
Surgical technique
Summary of clinical results (Tables 6.1-6.4)
Postoperative protocol
Pitfalls and complications
Editorial comment
References
7. Cemented acetabular revision for the distorted acetabulum with intact columns (type IIA, B, and C defects)
Background
Surgical technique
Common pitfalls and tendencies
Postoperative protocol and common complications9
Summary of clinical outcomes (Tables 7.1-7.3)
Illustrative case
Editorial comment
References
8. Cementless acetabular revision for severe acetabular bone loss without pelvic discontinuity (type IIIA and B defects)
Introduction
Surgical approach and exposure
Algorithmic approach to cementless reconstruction of IIIA and IIIB defects
Large hemispherical cups without augmentation (Jumbo cups)
Hemispherical cups with a high hip center
Porous metal augmentation
Custom triflange components
Double cup construct
Oblong and bilobed cups
Structural bone allograft
Conclusion
Editorial comment
References
9. Acetabular revision with impaction grafting for severe acetabular bone loss without pelvic discontinuity
Background
Patient positioning and surgical approach
Required equipment
Surgical technique
Case illustration-1 (Fig. 9.3)
Case illustration-2 (Fig. 9.4)
Technical concerns
Clinical outcomes
Acknowledgment
Editorial comment
References
10. Plating of an acute pelvic discontinuity
Background
Diagnosis and evaluation of APD
Surgical technique
Common pitfalls and tendencies
Postoperative protocol and common complications
Clinical outcomes
Illustrative case (Fig. 10.16)
Editorial comment
References
11. Intraoperative identification and bone grafting of a chronic pelvic discontinuity
Background
Intraoperative identification
Bone graft options
Surgical technique
Common pitfalls and tendencies
Postoperative protocol
Common complications
Illustrative case acute pelvic discontinuity
Illustrative case chronic pelvic discontinuity
Editorial comment
References
12. Primer on treatment options for chronic pelvic discontinuity
13. Cages/ reconstruction rings (Burch-Schneider/ Ganz) for reconstruction of chronic pelvic discontinuity
Background
Surgical technique
Common pitfalls and tendencies
Postoperative protocol and common complications
Summary of clinical outcomes (Tables 13.1–13.3)
Illustrative case
Editorial comment
References
14. Kerboull acetabular ring device with allograft for chronic pelvic discontinuity
Background
The Kerboull acetabular reinforcement device and its evolution
Mechanical principles
The KARD evolution
Surgical technique
Clinical outcomes
Conclusion
Illustrative case
Editorial comment
References
15. Acetabular impaction bone grafting for chronic p elvic discontinuity
Background
Surgical technique
Common pitfalls and tendencies
Postoperative protocol and common complications
Summary of clinical outcomes (Table 15.1)
Illustrative case
Editorial comment
References
16. Acetabular bone loss with chronic pelvic discontinuity: Acetabular cup-cage vs cage-augment reconstruction
Background
Surgical technique
Postoperative protocol and complications
Clinical outcomes
References
17. Cup-cage/half cage for chronic pelvic discontinuity
Introduction
History
Indications, contraindications, and alternatives
Instruments and implants
Surgical approaches and cage implantation
Postoperative regimen
Avoiding complications
Results
Illustrative case
Editorial comment
References
18. Ice cream cone (pedestal) prosthesis for chronic pelvic discontinuity
Background
Surgical planning
Surgical technique
Common pitfalls and tendencies
Postoperative protocol and common complications
Illustrative case
Editorial comment
References
19. Custom triflange acetabular component for chronic pelvic discontinuity
Background
Preoperative imaging
Surgical technique
Technical pearls and pitfalls
Postoperative protocol
Clinical outcomes
Complications
Cost considerations
Illustrative case
Editorial comment
References
20. Custom 3D-printed acetabular component for chronic pelvic discontinuity
Background
Surgical technique
Common pitfalls and tendencies
Postoperative protocol and common complications
Summary of clinical outcomes and complications (Table 20.1)
Illustrative case
Editorial comment
References
21. Jumbo cup and modular porous metal augments for chronic pelvic discontinuity
Background
Surgical technique
Common pitfalls and tendencies
Postoperative protocol
Summary of clinical outcomes in the literature (Tables 21.1-21.2)
Illustrative case
Summary
Editorial comment
Suggested readings
22. Acetabular distraction technique for chronic pelvic discontinuity
Background
Surgical technique
Common pitfalls and tendencies
Postoperative protocol and common complications
Summary of clinical outcomes (Table 22.1)
Illustrative case
Editorial comment
References
Index

Neil P. Sheth

Neil Sheth is the Chief of Orthopaedic Surgery and Assistant Professor of Orthopaedic Surgery at the University of Pennsylvania. He obtained his undergraduate degree in Biomedical Engineering with a minor in Finance at the University of Pennsylvania. He then spent 2 years on Wall Street as a Financial Analyst in Solomon Smith Barney's Healthcare Investment Banking division prior to attending medical school at the Albany Medical College. Following medical school, he completed a six-year Orthopaedic Surgery residency at the Hospital of the University of Pennsylvania. Following residency, he completed an adult hip and knee reconstruction fellowship at Rush University as well as a three month mini-fellowship at the Endo Klinik in Hamburg, Germany focusing on peri-prosthetic infection. Dr. Sheth returned in 2012 to join the faculty at the University of Pennsylvania and focuses his research on bone loss pertaining to revision total hip arthroplasty, peri-prosthetic infection and the role of orthopaedic surgery in global health.

Affiliations and expertise

Chief, Department of Orthopaedic Surgery, Pennsylvania Hospital; Director of Global Orthopaedics (www.globalortho.org); Site Director Pennsylvania Hospital – Adult Hip and Knee Reconstruction Fellowship; Assistant Professor, University of Pennsylvania Department of Orthopaedic Surgery, Philadelphia, Pennsylvania

Wayne Paprosky

Wayne Paprosky was one of the first surgeons to perform total hip surgery with cement less implants, which is today's standard. He developed the Paprosky Classification used worldwide for performing Revision surgery. Dr. Paprosky developed and implanted the first gender specific hip for women 15 years ago. These concepts have led to the development of today's gender specific implants for active females. In addition, Dr. Paprosky performs minimally invasive total hip and knee surgery enabling patients to go home within 24 hours.

Affiliations and expertise

Professor, Department of Orthopaedics, Section of Adult Joint Reconstruction, Rush Presbyterian-St. Luke’s Medical Center, Chicago, Illinois

Life sciences

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Social sciences & Humanities

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