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.

Keywords: Complication; femoral trial head; laparotomy; retrieval; total hip arthroplasty; total hip replacement..

Fig. (1)

Postoperative anteroposterior radiograph of the pelvis. Exact localization of the femoral trial head is impossible on plain radiographs.

Fig. (2)

Computerized Tomography of the pelvis allows the exact localization of the femoral trial head into the iliac muscle.

Fig. (3)

The femoral trial head was detected after performing a exploratory laparotomy in the musculus iliacus and was retrieved without any complications using a clamp.