Extended Ischiopubic Fixation Using Porous Metal Augments in Cementless Acetabular Reconstruction during Revision Total Hip Arthroplasty.

OBJECTIVES

The aims of this study were to introduce the definition, indication, and surgical technique of extended ischiopubic fixation (EIF) and to investigate the early clinical, radiographic results and complications of hips revised with EIF.

METHODS

Patients who underwent revision THA utilizing the technique of EIF which was defined as securing the porous metal augment >5 mm deep into the ischium and/or pubic ramus to gain adequate mechanical support and fresh host bone for bony ingrowth in a single institution from February 2015 to February 2020 were retrospectively reviewed. After applying the inclusion and exclusion criteria, a total of 30 hips (28 patients) were eligible for the study and were enrolled. Four patients were lost to follow-up postoperatively. The data of the remaining 24 patients (26 hips) were analyzed. The patients' clinical results were assessed using of the Harris Hip Score and any complications including postoperative periprosthetic joint infection, intraoperative fracture, postoperative periprosthetic fracture, dislocation, nerve palsy, hematoma or wound complication were documented. The radiographic results were assessed with the construct stability, the position of the center of rotation, and cup orientation.

RESULTS

The median age of these 25 patients was 62.00 (interquartile: 54.25-68.25) years, with a median body mass index (BMI) of 22.60 kg/m (interquartile: 21.49-25.12 kg/m ). A total of 12 (48%) patients were female. At a median duration of follow-up of 49.16 months, 20 (80%) patients rated their satisfaction level as "very satisfied," five (20%) were "satisfied." The median HHS improved from 36.00 (interquartile range: 31.25-49.75) preoperatively to 81.00 (interquartile range: 74.75-88.25) at the most recent follow-up (p < 0.001). No complications such as periprosthetic joint infection, intraoperative fracture, periprosthetic fracture, dislocation, nerve palsy, hematoma, or wound complication were identified. All constructs were considered to have obtained stable fixation. The median vertical and horizontal distance between the latest postoperative centers of rotation to the anatomic center of rotation improved from 13.62 and 8.68 mm preoperatively to 4.42 and 4.19 mm at final follow-up (p < 0.001).

CONCLUSIONS

Early follow-up of patients reconstructed with porous metal augments using the EIF technique demonstrated satisfactory clinical results with no particular complications, stable fixation, and restoration of the center of rotation.