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CLASSIFICATION OF PELVIC RESECTIONS
SURGICAL OPTIONS FOR THE PERIACETABULAR RESECTION
THE SADDLE PROSTHESIS
Historical Perspectives: The Mark I
Periacetabular Reconstruction Prosthesis (PAR)
SURGICAL TECHNIQUES AND CONSIDERATIONS
COMPLICATIONS AND IMAGING
PAR Page 1
PAR Page 2
COMPLICATIONS: MARK II PROSTHESIS
Renard et al.8 found that wound infection, prosthetic loosening with subsequent removal, transient neuropraxia, fracture due to falls, proximal migration, and heterotopic bone formation around prosthesis to be their most common complications.
Cephalad Migration
Severe cephalad saddle migration 2 months after insertion8
Aboulafia et al.3 found that 9/17 patients had at least one complication(53%)
ª Local wound infection, dislocations, prosthetic dissociation, pathologic fracture at femoral stem, partial sciatic nerve laceration were the most common complications.
Benevenia et al.1 found complications in 3/20 patients he treated for metastatic disease.
ª Wound infection, dislocations, fracture-dislocations, were most common, but these rates were comparable with other studies
NOTE: Only one patient was alive at the time of reporting the data View Kaplan-Meier Graph1
Dislocation
Complete anterior dislocation. Note how saddle prongs are rotated and disengaged from ilium from Benevenia et al. Contrast this with the normal axial CT.
Cottias et al.16 studied 17 patients and had a 65% complication rate.
ª 47% deep infection rate. As well, dislocation, SI joint subluxation, mechanical failure, sciatic nerve palsy(incomplete), upward migration ranging from 2mm to 3cm
ª No femoral loosening
ª One fractured intermediate component
Cephalad migration with subsequent fracture of screw. Note absence of bone sclerosis at interface of ilium and prosthesis16
Dislocation of prosthesis and subluxed SI joint. Note saddle angulation and widened SI joint(above right). This was subsequently relocated and the SI joint pinned.16
