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STAGED SURGICAL RECONSTRUCTION OF MASSIVE PELVIC DEFECT
- Authors: Pavlov V.V.1, Pronskikh A.A.1, Mamyladze T.Z.1, Bazlov V.A.1, Efimenko M.V.1, Zhilenko V.Y.2, Tsegelnikov M.M.3
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Affiliations:
- Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics.
- NIITO Clinic of Traumatology, Orthopaedics and Neurosurgery.
- State Novosibirsk Regional Clinical Hospital .
- Issue: Vol 24, No 3 (2018)
- Pages: 125-134
- Section: Case Reports
- Submitted: 07.10.2018
- Accepted: 07.10.2018
- Published: 07.10.2018
- URL: https://journal.rniito.org/jour/article/view/1051
- DOI: https://doi.org/10.21823/2311-2905-2018-24-3-125-134
- ID: 1051
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Abstract
Purpose of the study — to illustrate on a particular clinical case an option of treatment for patients with severe pelvic defects by a staged surgery: vascularized bone grafting and revision arthroplasty using custom made implant produced by laser sintering based on layered 3D-visualisation.
Material and Methods. Female, 61 years old, was admitted to clinic in 2016 with aseptic loosening of acetabular component and polyethylene insert wear following arthroplasty with total cementless prosthesis. Revision arthroplasty was made with hemispherical augment and anti-protrusion ring. On day 7th after the surgery a dislocation of prosthesis head, pubic bone fracture, migration of acetabular component and bone defect with pelvic discontinuity occurred due to trauma. To restore continuity of the pelvic ring and supportability of the lower limb the authors performed a staged multisession procedure: removal of prosthesis, free vascularized bone grafting by costal vascular pedicle graft and plating fixation of the pelvis. 6 months after the first stage a custom made prosthesis was implanted. Such prosthesis was produced based on a 3D pelvis reconstruction model by layered visualization and with evaluation of bone density on the Hounsfield scale and was printed on 3D-printer by laser sintering from LPW-TI64-GD23-TYPE5 titanium.
Results. The authors did not observe any septic complications, dislocations and components migration in the early postoperative period. Function was assessed by Harris Hip Score. Scores prior to arthroplasty by a custom made implant was 12 points, one month postoperatively — 30 points, three months postoperatively — 51 points, six months postoperatively — 74 points. Life quality scores by SF-36 were reported as follows: prior to surgery РН — 21.32; МН — 40.92; one month postoperatively РН — 40.66; МН — 55.80; three months postoperatively РН — 52.14; МН — 57.81; six months postoperatively РН — 62.46; МН — 72.08.
Conclusion. Vascularized bone autoplasty allows to restore pelvic continuity, and the use of custom made implants — to restore supportability of the lower limb and hip function in case of an extensive pelvic defect.
About the authors
V. V. Pavlov
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics.
Author for correspondence.
Email: fake@neicon.ru
Vitaliy V. Pavlov — Dr. Sci. (Med.), head of Department of Endoprosthetics and Endoscopic Joint Surgery.
17, ul. Frunze, 630091, Novosibirsk.
РоссияA. A. Pronskikh
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics.
Email: fake@neicon.ru
Aleksandr A. Pronskikh — cand. Sci. (Med.), researcher of department of endoprosthetics and endoscopic joint Surgery.
17, ul. Frunze, 630091, Novosibirsk.
РоссияT. Z. Mamyladze
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics.
Email: fake@neicon.ru
Tariel Z. Mamyladze — researcher of Department of Endoprosthetics and Endoscopic Joint Surgery.
17, ul. Frunze, 630091, Novosibirsk.
РоссияV. A. Bazlov
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics.
Email: fake@neicon.ru
Vyacheslav A. Bazlov — researcher of Department of Endoprosthetics and Endoscopic Joint Surgery.
17, ul. Frunze, 630091, Novosibirsk.
РоссияM. V. Efimenko
Tsivyan Novosibirsk Research Institute of Traumatology and Orthopaedics.
Email: fake@neicon.ru
Maksim V. Efimenko — orthopedic surgeon of Orthopedic Department N 2.
17, ul. Frunze, 630091, Novosibirsk.
РоссияV. Yu. Zhilenko
NIITO Clinic of Traumatology, Orthopaedics and Neurosurgery.
Email: fake@neicon.ru
Valentin Y. Zhilenko — chief of Department of Ortopaedic Surgery.
19a, ul. Frunze, 630091, Novosibirsk.
РоссияM. M. Tsegelnikov
State Novosibirsk Regional Clinical Hospital .
Email: fake@neicon.ru
Maksim M. Tsegelnikov — chief of Department of Plastic and Reconstructive Surgery.
130, ul. Nemirovicha-Danchenko, 630087, Novosibirsk.
РоссияReferences
- Mahomed N.N., Barrett J.A., Katz J.N., Phillips C.B., Losina E., Lew R.A. et al. Rates and outcomes of primary and revision total hip replacement in the United States medicare population. J Bone Joint Surg Am. 2003;85(1):27-32.
- Singh J.A., Schleck C., Harmsen S., Lewallen D. Clinically important improvement thresholds for Harris Hip Score and its ability to predict revision risk after primary total hip arthroplasty. BMC Musculoskelet Disord. 2016;17(1):256. doi: 10.1186/s12891-016-1106-8.
- Kurtz S., Ong K., Lau E., Mowat F., Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007;89(4):780-785. doi: 10.2106/JBJS.F.00222.
- Тихилов Р.М., Шубняков И.И., Коваленко А.Н., Черный А.Ж., Муравьева Ю.В., Гончаров М.Ю. Данные регистра эндопротезирования тазобедренного сус тава РНИИТО им. Р.Р. Вредена за 2007–2012 годы. Травматология и ортопедия России. 2013;(3):67-190. doi: 10.21823/2311-2905-2013--3-167-190.
- Li H., Qu X., Mao Y., Dai K., Zhu Z. Custom Acetabular Cages Offer Stable Fixation and Improved Hip Scores for Revision THA with Severe Bone Defects. Clin Orthop Relat Res. 2015;474(3):731-740. doi: 10.1007/s11999-015-4649-3.
- Мурылев В.Ю., Петров Н.В., Селин Н.Н., Рукин Я.А., Елизаров П.М., Калашник А.Д. Ревизионное эндо-протезирование вертлужного компонента эндопро-теза тазобедренного сустава. Кафедра травматологии и ортопедии. 2012;(1):20-25.
- Мурылев В.Ю., Терентьев Д.И., Елизаров П.М., Рукин Я.А., Казарян Г.М. Тотальное эндопротезирование тазобедренного сустава с использованием танталовых конструкций. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2012;(1):24-29.
- Paprosky W.G., Perona P.G., Lawrence J.M. Acetabular defect classification and surgical reconstruction in revision arthroplasty: a 6-year follow up evaluation. J Arthroplasty. 1994;9(1):33-44.
- Saleh K.J., Holtzman J., Gafni A Saleh L., Jaroszynski G., Wong P., Woodgate I. et al. Development, test reliability and validation of a classification for revision hip arthroplasty. J Orthop Ralat Res. 2001;19(1): 50-56.
- Berry D.J., Lewallen D.G., Hanssen A.D. Cabanela M.E. Pelvic discontinuity in revision total hip arthroplasty. J Bone Joint Surg Am. 1999;81(12):1692-1702.
- Садовой М.А., Павлов В.В., Базлов В.А., Мамуладзе Т.З., Ефименко М.В., Аронов А.М., Панченко А.А. Возможности 3D-визуализации дефектов вертлужной впадины на этапе предоперационного планирования первичного и ревизионного эндопротезирования тазобедренного сустава. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2017;(3):37-42.
- Хоружик С.А. Михайлов А.Н. Основы КТ-визуализации. Часть 1. Просмотр и количественная оценка изображений. Радиология – практика. 2011;(3):62-75.
- Корыткин А.А., Захарова Д.В., Новикова Я.С., Горбатов Р.О., Ковалдов К.А., Эль Мудни Ю.М. Опыт применения индивидуальных трехфланцевых верт-лужных компонентов при ревизионном эндопроте-зировании тазобедренного сустава. Травматология и ортопедия России. 2017;23(4):101-111.doi: 10.21823/2311-2905-2017-23-4-101-111.
- Тихилов Р.М., Шубняков И.И., Коваленко А.Н., Билык С.С., Цыбин А.В., Денисов А.О. Применение индивидуальной трехфланцевой конструкции при ревизионном эндопротезировании с нарушением целостности тазового кольца (клинический случай). Травматология и ортопедия России. 2016;(1):108-116. doi: 10.21823/2311-2905-2016-0-1-108-116.
- Berasi C.C., Berend K.R., Adams J.B., Ruh E.L,. Lombardi A.V. Are custom triflange acetabular components effective for reconstruction of catastrophic bone loss? Clin Orthop Relat Res. 2014;473(2):528-535. doi: 10.1007/s11999-014-3969-z.
- Goodman G.P., Engh C.A. The custom triflange cup: build it and they will come. Bone Jt J. 2016;98(1):68-72. doi: 10.1302/0301-620x.98b.36354.
- Hogan C., Ries M. Treatment of massive acetabular bone loss and pelvic discontinuity with a custom triflange component and ilio-sacral fixation based on preoperative CT templating. A report of 2 cases. Hip Int. 2015;25(6):585-588. doi: 10.5301/hipint.5000247.
- Sheth N.P., Melnic C.M., Paprosky W.G. Acetabular distraction: an alternative for severe acetabular bone loss and chronic pelvic discontinuity. Bone Joint J. 2014; 96-B(11):36-42. doi: 10.1302/0301-620x.96b11.34455.
- Taunton M.J., Fehring T.K., Edwards P., Bernasek T., Holt G.E., Christie M.J. Pelvic discontinuity treated with custom triflange component: a reliable option. Clin Orthop Relat Res. 2011;470(2):428-434. doi: 10.1007/s11999-011-2126-1
- Abdelnasser M.K., Klenke F.M., Whitlock P., Khalil A.M., Khalifa Y.E., Ali H.M. et al. Management of pelvic discontinuity in revision total hip arthroplasty: a review of the literature. Hip Int. 2015;25(2):120-126. doi: 10.5301/hipint.5000201.
- Wilden J.A., Moran S.L., Dekutoski M.B., Bishop A.T., Shin AYS. Results of vascularized rib grafts in complex spinal reconstruction. J Bone Joint Surg Am. 2006;88(4): 832-839. doi: 10.2106/JBJS.E.00409.
- Beekmans S., Don Griot J., Mulder J. Split rib cranioplasty for aplasia cutis congenita and traumatic skull defects: more than 30 years of follow-up. J Craniofac Surg. 2007;18(3):594-597. doi: 10.1097/scs.0b013e3180576f44.
- Bapat M.R., Chaudhary K., Garg H., Laheri V. Reconstruction of large iliac crest defects after graft harvest using autogenous rib graft: a prospective controlled study. Spine (Phila Pa 1976). 2008;33(23): 2570-2575. doi: 10.1097/BRS.0b013e318185287d.
- Foster R.D., Anthony J.P., Sharma A., Pogrel M.A. Vascularized bone flaps versus non-vascularized bone grafts for mandibular reconstruction: An outcome analysis of primary bony union and endosseous implant success. Head Neck. 1999;21(1):66-71.
- Hildago D.A., Pusic A.L. Free flap mandibular reconstruction: A 10-year follow-up study. Plast Reconstr Surg. 2002;110(2):438-449.
- Jain S., Grogan R.J., Giannoudis P.V. Options for managing severe acetabular bone loss in revision hip arthroplasty. A systematic review. Hip Int. 2014;24(2):109-122. doi: 10.5301/hipint.5000101.
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