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Case Reports
. 2017 Oct 9;4(1):44-50.
doi: 10.1016/j.artd.2017.08.002. eCollection 2018 Mar.

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

Ahmed Siddiqi  1 , Carl T Talmo  2 , James V Bono  2
Affiliations
Case Reports

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

Ahmed Siddiqi et al. Arthroplast Today. .

Abstract

Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.

Keywords: Complications; Femoral head dislodgement; THA; Total hip arthroplasty.

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Figures

Figure 1
Figure 1
Inverted kidney, ureter, and bladder (KUB) radiograph demonstrating subtle radio-opaque density (arrows) with 2 metallic dots inside the trial femoral head.
Figure 2
Figure 2
Retrieval of a lost femoral trial head deep in the pelvis using a Satinsky aortic clamp.
Figure 3
Figure 3
Algorithm for decision-making and treatment for the dislocated trial femoral head. MSCT, multislice CT; PJI, periprosthetic joint infection.
Figure 4
Figure 4
Supine anteroposterior pelvis radiographs from case 1, case 3, and case 4 showing measurements for cup anteversion and abduction angles within the Lewinnek safe zone . Line B is the tangent line to the opening of the acetabular cup and intersects with the interobturator reference line A on the pelvis providing the abduction angle. The ellipse that measures the anteversion angle is shown by the contour of the acetabular cup opening and is concentric with the circle surrounding the acetabular cup. The measurements were done after calibration using the TraumaCad software.
See this image and copyright information in PMC

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