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Early Postoperative Transverse Pelvic Fracture: A New Complication Related to Revision Arthroplasty with an Uncemented Cup
Bryan D. Springer, MD1; Daniel J. Berry, MD2; Miguel E. Cabanela, MD2; Arlen D. Hanssen, MD2; David G. Lewallen, MD2
1 OrthoCarolina Hip and Knee Center, 1915 Randolph Road, Charlotte, NC 28209. E-mail address: bryan.springer@orthocarolina.com
2 Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905
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A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Zimmer, Implex (A.D.H., D.G.L.), Stryker (M.E.C.), and DePuy (D.J.B.). In addition, one or more of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity (Zimmer; Implex [A.D.H., D.G.L.]; Stryker [M.E.C.]; and DePuy [D.J.B.]). No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Mayo Clinic, Rochester, Minnesota

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Dec 01;87(12):2626-2631. doi: 10.2106/JBJS.E.00088
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Background: Uncemented hemispherical cups are commonly used to revise failed acetabular total hip components, even in the presence of marked acetabular bone loss. The purpose of the present study was to report a new complication of acetabular component revision with an uncemented hemispherical cup.

Methods: We retrospectively reviewed the records of seven patients (seven hips) in whom an early postoperative transverse acetabular fracture had developed following the implantation of an uncemented trabecular metal cup for the revision of a failed acetabular component. All patients were female. The average age was 63.6 years. The reason for acetabular revision was aseptic loosening of the original cup in five patients and reimplantation after a previous resection arthroplasty in the remaining two. The average cup size used for revision was 58 mm. In two hips, additional modular acetabular metal augments were used to restore the acetabular rim.

Results: The average postoperative time to diagnosis of a transverse acetabular fracture was eight months. Five of the seven patients presented with a marked acute increase in pain and a new displaced transverse acetabular fracture (pelvic discontinuity) that was visible on plain radiographs. Two patients were asymptomatic but had a nondisplaced transverse acetabular fracture. In all seven patients, the trabecular metal socket appeared radiographically to be well fixed to part of the pelvis. The five patients with a displaced fracture were managed with additional surgery to stabilize the fracture.

Conclusions: To our knowledge, early postoperative transverse pelvic fractures following revision of the acetabular component have not been reported previously. The most likely causes of this complication are further weakening of the remaining pelvic bone stock as a result of the reaming required to obtain a secure fit of a large-diameter hemispherical socket and the cyclic stresses on the weakened bone with resumption of walking. It is unlikely that the fractures occurred intraoperatively because in each case the socket remained well fixed to one of the pelvic fragments.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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