Preoperative Radiographic Evaluation of Patients With Pelvic Discontinuity

Background: Pelvic discontinuity (PD) is a rare but devastating mechanism of failure in total hip arthroplasty. Radiographic findings have been described for the identification of PD. However, no study has specifically examined radiographic parameters and the utility of specific views in the preoperative identification of PD.

Methods: We performed a retrospective review of 133 patients who underwent acetabular revision for PD. Preoperative radiographic studies were reviewed including anteroposterior pelvis (AP; n = 133), true lateral hip (n = 132), Judet (n = 47), false profile (n = 4), and computed tomography scans (n = 14). Radiographs were read by the senior authors to identify the following parameters suggestive of PD: visible fracture line, medial migration of the inferior hemipelvis, and obturator ring asymmetry.

Results: Using only the AP view, the fracture line was visible in 116 (87%), medial migration of the inferior hemipelvis in 126 (95%), and obturator ring asymmetry in 114 (86%). A fracture line was visualized in 65 of 132 hips (49%) evaluated with laterals, 36 of 47 hips (77%) evaluated with Judet views, 3 of 4 (75%) evaluated with a false profile view, and 10 of 14 (71%) evaluated with computed tomography.

Conclusion: Preoperative evaluation with a combination of an AP pelvis radiograph, plus a true lateral radiograph of the hip, plus Judet films in combination with the criteria for discontinuity defined in this article, allowed for identification of PD in a 100% of patients.