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Case Reports
. 2016 Summer;16(2):185-90.

Total Hip Arthroplasty Dislocations Are More Complex Than They Appear: A Case Report of Intraprosthetic Dislocation of an Anatomic Dual-Mobility Implant After Closed Reduction

Bradford S Waddell  1 , Ivan De Martino  1 , Thomas Sculco  1 , Peter Sculco  1
Affiliations
Case Reports

Total Hip Arthroplasty Dislocations Are More Complex Than They Appear: A Case Report of Intraprosthetic Dislocation of an Anatomic Dual-Mobility Implant After Closed Reduction

Bradford S Waddell et al. Ochsner J. 2016 Summer.

Abstract

Background: Total hip arthroplasty is a successful operation for the treatment of hip pain. One of the common complications of hip arthroplasty is dislocation. While reduction of standard prosthetic dislocations is highly successful, new prostheses add the potential for new complications.

Case report: We present the case of a patient who experienced intraprosthetic dislocation of an anatomic dual-mobility total hip prosthesis after a closed hip reduction and include the prereduction and postreduction radiographic findings.

Conclusion: Emergency department physicians should be aware of intraprosthetic dislocation. This complication can be easily missed because the metal/ceramic femoral head appears to be reduced in the acetabulum.

Keywords: Arthroplasty–replacement–hip; hip dislocation; hip prosthesis.

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Figures

Figure 1.
Figure 1.
In the typical dual-mobility construct, a small central metal or ceramic head couples with a large polyethylene head inside the acetabular cup.
Figure 2.
Figure 2.
X-ray shows the dislocated and uncoupled polyethylene head in the soft tissue. The arrows surround the bubble sign of the polyethylene head apparent in the soft tissue.
Figure 3.
Figure 3.
Our patient's initial x-ray after dislocation. The properly coupled large polyethylene head can be seen as a shadow around the small femoral head.
Figure 4.
Figure 4.
Our patient's x-ray after the reduction attempt. The small femoral head is eccentric inside the acetabular cup. The arrows show the dissociated polyethylene femoral head in the soft tissue.
Figure 5.
Figure 5.
A: Coronal computed tomography (CT) image shows the polyethylene head dissociated and in the soft tissue. The arrows surround the polyethylene head. B: In a similar CT image in the axial plane, the arrows show the polyethylene head.
Figure 6.
Figure 6.
A: Intraoperative photograph of our patient. After slight dissection down, the polyethylene head was visualized and photographed. B: Our patient's dissociated dual-mobility prosthesis in the operating room after removal.
Figure 7.
Figure 7.
Postoperative x-ray shows the concentric reduction and proper alignment after revision dual-mobility implant.
See this image and copyright information in PMC

References

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