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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
- 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.
Russian FederationA. 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.
Russian FederationT. 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.
Russian FederationV. 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.
Russian FederationM. 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.
Russian FederationV. 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.
Russian FederationM. 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.
Russian FederationReferences
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