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

Abstract

SUMMARYDislocation of the trial femoral head is a rare and unpleasant event that can compromise the success of the total hip arthroplasty. A 62-year-old Caucasian woman with osteoarthritis was admitted to our Department and underwent an elective total hip arthroplasty. While performing the dislocation manoeuver the trial femoral head dissociated from the taper in the superior and anterior direction in the soft tissue and could not be retrieved immediately. The operation was then executed and finished in an ordinary manner. Three months after discharge from our department patient presented with the pain in the hip and groin and periprosthetic joint infection was diagnosed. The successful second operation for the retrieval of the dislocated trial femoral head was conducted through ilioinguinal approach. In this paper we reviewed the published literature and developed the algorithm for the decision-making while dealing with the dislocated and lost trial femoral head. BACKGROUND

A safe method for the retrieval of a dislocated trial head in total hip arthroplasty

“…12 However, retrieval may be necessary due to the risk of later complications and infection. 13,14 We describe a case similar to the ones in the literature, but with a novel safe and easy way of removal of the dislocated head at the time of primary surgery utilising an approach a general orthopaedic surgeon and resident would be familiar with.…”

“…7 Various complications have been described with a few case reports of a dislocated trial head into the pelvis while performing a contemporary hip replacement described in the literature. [8][9][10][11][12][13][14][15] There are also case reports of dual mobility bearing surface dislocations. 16,17 This complication can cause concerns for patient safety with increased risk of infection whilst also being deeply frustrating for the operating surgeon.…”

“…9,10,14,18,19 The trial head can be left in the pelvis if not causing any obstructive symptoms. 12 However, retrieval may be necessary due to the risk of later complications and infection.…”

Intrapelvic dislocation of trial femoral prosthesis in hip arthroplasty

“…Intrapelvic migration of prosthesis is a rare complication of total hip arthroplasty and is poorly documented in the literature . In this case, a capsular breach was created while removing the anterior osteophytes.…”

“…A number of approaches were utilized, including Smith–Petersen, ilioinguinal, laparotomy and laparoscopy. Reasons for delayed retrieval included clicking, pelvic pain and removal during revision for prosthetic infection . Other potential considerations include compression of the vital structures or patient age – it may be desirable to opt towards retrieval in younger patients, where the long‐term foreign body reaction towards the plastic of trial femoral heads is unknown.…”