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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 5,
574-578.
doi: 10.1302/0301-620X.90B5.19789 Copyright © 2008 by British Editorial Society of Bone and Joint Surgery The survival of support rings in complex acetabular revision surgeryF. A. Carroll, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon1; D. A. Hoad-Reddick, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon2; R. M. Kerry, FRCS(Tr & Orth), Consultant Orthopaedic Surgeon3; and I. Stockley, MD, FRCS, Consultant Orthopaedic Surgeon3
1 Wirrall University Teaching Hospital, NHS Foundation Trust, Arrowe Park Road, Upton, Wirral CH49 5PE, UK. Correspondence should be sent to Mr F. A. Carroll; e-mail: fa.carroll{at}virgin.net
Between 1980 and 2000, 63 support rings were used in the management of acetabular deficiency in a series of 60 patients, with a mean follow-up of 8.75 years (2 months to 23.8 years). There was a minimum five-year follow-up for successful reconstructions. The indication for revision surgery was aseptic loosening in 30 cases and infection in 33. All cases were Paprosky III defects; IIIA in 33 patients (52.4%) and IIIB in 30 (47.6%), including four with pelvic dissociation. A total of 26 patients (43.3%) have died since surgery, and 34 (56.7%) remain under clinical review. With acetabular revision for infection or aseptic loosening as the definition of failure, we report success in 53 (84%) of the reconstructions. A total of 12 failures (19%) required further surgery, four (6.3%) for aseptic loosening of the acetabular construct, six (9.5%) for recurrent infection and two (3.2%) for recurrent dislocation requiring captive components. Complications, seen in 11 patients (18.3%), included six femoral or sciatic neuropraxias which all resolved, one grade III heterotopic ossification, one on-table acetabular revision for instability, and three early post-operative dislocations managed by manipulation under anaesthesia, with no further instability. We recommend support rings and morcellised bone graft for significant acetabular bone deficiency that cannot be reconstructed using mesh.
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