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

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.

How did a prosthetic femoral head migrate to the mesorectum?

“…We believe that subsequent internal rotation probably occurred as the hip attempted to relocate, resulting in impaction of the femoral head against the acetabular component rim and disengagement. Other risk factors for component separation, including obesity and reduced head–neck ratio,1 were not applicable to this case (body mass index 26, standard offset prosthetic head).…”

Minimally invasive laparoscopic transabdominal retrieval of dislocated trial femoral head prosthesis

“…Dislocation of trial femoral head prosthesis is an uncommon complication of total hip arthroplasty, and the literature on management of this clinical scenario is sparse 1–3. Options for management that have been described include permanently leaving the trial prosthesis in situ,1 retrieval of the trial prosthesis at the time of initial procedure via one of a variety of open approaches (extended hip approach,4 modified Stoppa approach5 or ilioinguinal approach6), and retrieval at a subsequent procedure via laparotomy7 or laparoscopy 8…”

Ultrasound-assisted surgical retrieval of the lost femoral trial head during total hip arthroplasty

“…There are several options when challenged with such a situation: leave the trial head in the body without further intervention; extend the hip incision to retrieve it during the arthroplasty procedure; or complete the arthroplasty procedure, determine the location of the trial femoral head using advanced imaging techniques (such as computed tomography and magnetic resonance imaging), and arrange for a subsequent surgical intervention. 3 Typically, the third option is chosen but this is time-consuming and involves coordinating multidisciplinary teams. Furthermore, transportation of an anesthetized patient out of the operating room for advanced imaging is challenging in itself and it may compromise the patients' safety.…”

“…Most case reports indicate that, after being lost in the surgical field, the trial heads had migrated to adjacent cavities, beneath or along the iliopsoas muscle through the lacuna musculorum of the inguinal canal along the anterior pelvic brim. 3 In this region, other than the ileum, there are no bony structures. Theoretically, a hyperechoic structure should be readily identified in this area with ultrasound scanning.…”