Gross v. Berend: The Cup Cage Construct: Preferred Solution for Pelvic Discontinuity

In more recent results—121 patients have had cup cages. We’ve had 60 with a pelvic discontinuity. The average follow-up is almost four years (range: 1 – 153 months) and we’ve had an 11% revision rate. Pretty good.

Now the advantages of the cup cage—it’s off the shelf customization. Pelvic discontinuity may be an intraoperative finding. You can do a demitasse cup. If you come from Canada and you speak French—you know that a demitasse is a half of a cup. In one particular case, on the one side we did a cup cage but on the other side, we could not stabilize the cup for a cup cage, so we did the demitasse cup cage and used an augment to bridge the discontinuity.

Bone stock can be restored when you do a cup cage…by bone or by augments. Surprises can be managed by our big box of toys. If you like Ikea or Lego, cup cage is for you.

Finally, in one very, very difficult case I thought definitely we would need a triflange cup, so we ordered one. Wrong!  We can make a cup cage look like a triflange cup. There’s almost nothing we can’t tackle without having to order a custom device.

In closing, as Donald Trump would say…”I think this is probably the greatest invention in the history of mankind.”  Except perhaps, well no, not perhaps, a distant second or third would be the wheel and fire.

Dr. Berend:  So, I’m going to take an approach that is slightly different.

We all know what acetabular disasters are and what we’re really talking about here are the combined disasters or the discontinuities. And the real question of this debate is…is the cup cage the preferred solution for these significant acetabular problems.

It’s a great concept. As was just said, interestingly, it is the ultimate Lego set. And if I had a pair of twins running around that were age 3 or 4 at home and I played with Legos every day—which I don’t…I’m an empty nester—I would be into things where I can reconstruct and pull the box of toys out and put the green Lego with the blue Lego. And if I did this at home every day…I’d probably be very, very good at it. And that’s what Legos accomplish and I think that’s what Dr. Gross is very, very good at accomplishing.

The issue for me is, I’m an empty nester and so instead of playing with Legos at night, I have to get my instructions and follow the instructions in order to have a successful result. And I want to be able to do the same thing in the operating room.

I need to identify the bad problem. I need to understand the deformity. I need to use mypreferred solution and I need to get stable fixation.

We’re all trying to accomplish the same thing. Put something between the butt and the ground.