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Retention of a Well-Fixed Acetabular Component in the Setting of Massive Acetabular Osteolysis and Pelvic DiscontinuityA Case Report
Murat Pekmezci, MD1; James Keeney, MD2; Amanda Schutz, PhD3; John C. Clohisy, MD3
1 Division of Orthopaedic Surgery, San Francisco General Hospital, 1001 Potrero Avenue, Room 3A36, San Francisco, CA 94110
2 Wilford Hall Medical Center, United States Air Force, 2200 Bergquist Drive, San Antonio, TX 78236
3 Department of Orthopaedic Surgery, Washington University School of Medicine, 1 Barnes-Jewish Hospital Plaza, Suite 11300 WP, Campus Box 8233, St. Louis, MO 63110. E-mail address for J.C. Clohisy: jclohisy@wustl.edu
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Sep 01;91(9):2232-2237. doi: 10.2106/JBJS.H.01336
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The management of massive pelvic osteolysis can pose a substantial challenge when a revision total hip arthroplasty is performed. For patients with well-fixed, well-positioned acetabular components and with contained osteolytic defects, retention of the prosthesis with bone-grafting of the osteolytic lesions is an accepted surgical strategy1-4. In contrast, in the setting of massive osteolysis with pelvic discontinuity, the acetabular component is usually loose and must be revised. To our knowledge, the uncommon clinical scenario in which pelvic discontinuity and massive osteolysis are associated with a well-fixed acetabular component has not been discussed in the literature. In the following case report, we describe the surgical treatment and clinical results of a patient with this challenging combination of problems. The patient was managed with acetabular component retention, open reduction and internal fixation of the discontinuity, and morselized bone-grafting of the osteolytic bone defects. The patient was informed that data concerning the case would be submitted for publication, and she consented.
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