GIF89aì>³™

INTRODUCTION

PELVIC BONE ANATOMY

CLASSIFICATION OF PELVIC RESECTIONS

SURGICAL OPTIONS FOR THE PERIACETABULAR RESECTION

Hemipelvectomy

Arthrodesis

Megaprosthesis

THE SADDLE PROSTHESIS

Historical Perspectives: The Mark I

Mark II Prosthesis

Periacetabular Reconstruction Prosthesis (PAR)

INDICATIONS

SURGICAL TECHNIQUES AND CONSIDERATIONS

The Notch Osteotomy

Soft Tissue Tension

NORMAL POSTOPERATIVE IMAGING

COMPLICATIONS AND IMAGING

Mark I

Mark II

PAR Page 1

PAR Page 2

RECOVERY AND FUNCTIONALITY

CONCLUSION

REFERENCES

The idea for the saddle prosthesis came from a German physician named Elmar Nieder at the EndoKlinic in Hamburg circa the 1970's. He noted that in patients with severely failed hip arthroplasties (infected or aseptic but with extensive bone loss) despite the loss of the entire floor of the acetabulum, they still had painless articulation between the neck of the femoral prosthesis and roof remnant.  Movement was extremely limited yet it was a stable situation.¹²

The Mark I Prosthesis

Failed hip arthroplasty treated with Mark I paddle prosthesis. Note the superior migration after four years.¹²

Drawbacks:¹²

ªUltra rigid system

ªLimited intraoperative adjustability, i.e., one size fits all

ªProne to fracture, loosening and cephalad migration

ªMounted directly to femoral component with limited rotation

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Note the similarity to the saddle at left minus the stirrup

F

The Mark I Prosthesis (Link America, New Jersey)¹²