Intrapelvic Dislocation of a Femoral Trial Head During Primary Total Hip Arthroplasty Requiring Laparotomy for Retrieval

Abstract

Background and Purpose:Total hip arthroplasty (THA) is a safe and reliable surgical procedure. However, THA also has intra- and postoperative complications. A dreaded and frustrating intraoperative complication during total hip arthroplasty is dislocation of the femoral trial head from the neck into the pelvis.Methods:Here, we report on the case of a 71-year old female patient with osteoarthritis of the left hip. Total hip arthroplasty was performed in a lateral position through a standard posterior approach. During intraoperative trial reduction, the femoral trial head dissociated from the taper and dislocated into the psoas compartment. Several unsuccessful attempts, including an additional ventral approach, were made to immediately retrieve the femoral trial head.Results and interpretation:Postoperative a Computerized Tomography (CT) was performed to locate the trial head, a secondary explorative laparotomy was undertaken to retrieve it. The retrieval of the femoral trial head should be performed in a planned second surgical procedure to avoid possible complications during the manipulation necessary for retrieval.

Intraoperative femoral head dislodgement during total hip arthroplasty: a report of four cases

“…Despite great clinical outcomes and patient satisfaction rates [20] , intraoperative complications during THA are not uncommon, occurring in approximately 5.4% of cases, with femur fractures occurring most commonly [21] . Trial femoral head dislocation into the retroperitoneum is a much rarer complication with limited previous reports ( Table 2 ) [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . Although the overall occurrence rate is undetermined, the incidence of this complication at our institution for 34,198 primary THAs from 1998 to present was extremely rare at 0.01%.…”

“…Total hip arthroplasty (THA) is one of the most successful and cost-efficient procedures in medicine; however, complications may occur up to 22% [1] , [2] , [3] , [4] . Dislodgement of trial femoral heads and migration into the pelvis is a rarely reported complication with only 14 published cases [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] . Although a handful of reports are described in the literature, the true incidence of this complication is unknown.…”

Dissociation and Intrapelvic Entrapment of a Dual-mobility Polyethylene Component

“…Patients understandably will be concerned by the idea of leaving the component in place, however education regarding the potential complications of retrieval including hernia, neurovascular injury, or urologic injury should be discussed. Retrieval of trial femoral heads entrapped in the pelvis may be performed through a separate surgical approach at the time of surgery [3,5,13]. One study regarding leaving trial femoral heads that have become entrapped intrapelvically did not identify adverse effects, and patients have remained asymptomatic when such implants have been left in an intrapelvic position [2].…”

Dislocated trial femoral head during total hip arthroplasty: review of the literature and the new algorithm for treatment

“…Citak et al 3 performed laparotomy in order to retrieve the trial head although there are reports of a potentially less invasive laparoscopic retrieval in the setting of the abdominal cavity localisation 10. We favour laparotomy over any kind of laparoscopic solution because of two reasons.…”