Retention of a well-fixed acetabular component in the setting of massive acetabular osteolysis and pelvic discontinuity. A case report.

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. A sixty-one-year-old woman presented to us with right-sided groin pain nine years after a right primary total hip arthroplasty. The postoperative course had been uncomplicated, and she had remained asymptomatic until eight months prior to the time of presentation. She had no history of trauma. The pain was worse with activity and improved with rest. She had no fever or other constitutional symptoms. The medical history was notable for obesity, coronary artery disease that required coronary artery bypass grafting six months prior to presentation, and a previous episode of diverticulitis, which required a partial colectomy to manage acute intestinal obstruction. She also had a history of cholecystectomy, multiple hernia repairs, and left hip and right knee replacements. She was retired, divorced, and living alone. The cardiovascular disease limited her to walking inside her home. On physical examination, she …