Outcomes in Acetabular Revision for Acute Pelvic Discontinuity Utilizing Plating of the Posterior Column

Background: Acute pelvic discontinuity (PD) is a rare, yet challenging complication following total hip arthroplasty (THA). Although several techniques, such as plating of the posterior column and spanning of the discontinuity with a cup cage, have been described for the management of acute PD, few studies have determined the survivorship of acetabular constructs in this setting. The purpose of this study was to determine the outcomes of acetabular fixation of the posterior column in patients who had acute PD following THA.

Methods: We reviewed a consecutive series of 24 patients diagnosed with acute PD at a single institution from 2018 to 2022. All patients were managed with open reduction and internal fixation of the discontinuity with a posterior column plate and highly porous cup. The primary outcome was acetabular component survivorship using Kaplan-Meier analysis. Secondary outcomes included rates of radiographic union of the fracture, aseptic loosening, dislocation, and infection.

Results: There were 17 women and seven men who had a mean age of 73 years (range, 50 to 89) included in the analysis. At 3.5 years of (range, 1.0 to 6.2) follow-up, implant survivorship free from aseptic acetabular failure was 91.7% upon Kaplan-Meier analysis. There was one patient who underwent acetabular rerevision secondary to component loosening in the early postoperative period, while one patient had radiographic evidence of acetabular cup loosening at 1-year follow-up. No other revision procedures, periprosthetic fractures, prosthetic dislocations, or nerve injuries were reported. The overall complication rate was 20.8%. There were three patients who required irrigation and debridement, while two patients experienced medical complications.

Conclusions: Posterior column plating with a highly porous acetabular cup can be a reliable treatment option for the management of acute PD. However, future studies with longer follow-ups comparing implant survivorship between posterior column plating and cup-cage constructs are necessary.