Case Reports
Treatment of Acetabular Nonunion and Posttraumatic Arthritis With Bone Grafting and Total Hip Arthroplasty
Am J Orthop. 2009 March;38(3):138-141
Author and Disclosure Information
Paul S. Issack, MD, PhD, Mark P. Figgie, MD, and David L. Helfet, MD
Dr. Issack is Fellow, Orthopaedic Trauma, Adult Reconstructive Surgery and Metabolic Bone Disease, and Dr. Figgie is Attending Orthopaedic Surgeon, Hospital for Special Surgery, New York, New York.
Dr. Helfet is Attending Surgeon and Director, Orthopaedic Trauma Service, Hospital for Special Surgery and Weill-Cornell Medical Center, New York, New York.
Abstract not available. Introduction provided instead.
Nonunion of the acetabulum compounded by posttraumatic arthritis is a very rare and complex condition requiring treatment of both the acetabular fracture and hip joint degeneration. A similar reconstructive problem has been observed during
revision hip surgery with major bone loss and pelvic discontinuity. These reconstructions, which comprise less than 1% of acetabular revisions, have a high failure rate when the pelvic disruption is not stabilized before arthroplasty.1-3 Several types of acetabular reconstructions, including porous-coated cups and triflanged cages, have demonstrated a high failure rate when the posterior column
is not stabilized.1,3-10 Reconstructing the pelvic discontinuity with posterior column plating before joint reconstruction has yielded acceptable outcomes.1,11-13
However, the literature includes few reports on managing acetabular nonunion in cases in which the native hip joint requires reconstruction. Reconstruction in this
situation may differ from the revision arthroplasty setting because the bone quality encountered when revising a pelvic discontinuity is usually poor, secondary to micromotion at the implant–bone interface and potential stress
shielding of pelvic bone stock from prior implants.1,14 The treatment options in the primary arthroplasty setting are 1-stage reconstruction of acetabular fracture and
hip joint and a 2-stage procedure with hip arthroplasty following operative stabilization and healing of the acetabular fracture. The 1-stage option was chosen for the patient described here. This patient, who was informed that data concerning his case would be submitted for publication, had acetabular nonunion and posttraumatic hip joint arthritis.