Periprosthetic Fracture of Greater Trochanter in Total Hip Replacement Stemming from Pin Site Placement in Navigation-Assisted Surgery

Abstract

Surgeons are looking to use computer computer-assisted surgery (CAS) in total hip arthroplasty (THA) in order to quantify leg length measurement, angular cup placement, and enhance stability to provide enhanced accuracy in implant placement. As a result, CAS in THA is gaining popularity. This technology employs the use of pins and provides the surgeon with real-time feedback on positioning intraoperatively. Previous total knee arthroplasty (TKA) literature has reported pin-associated complications such as infections, neuropraxia, and suture abscess. To our knowledge, there have been reports of tibial stress fracture after CAS TKA, but this is the first report of a pin causing fracture of the greater trochanter leading to dislocation in THA. Further studies may be warranted to optimize pin placement for trackers to prevent fractures of the greater trochanter.

Intraperitoneal Loss of Pelvic Array Pin During Navigated Total Hip Arthroplasty

“…An essential aspect of the procedure is to insert intraosseous iliac array pins to establish a stable reference of patient position for the navigation software. While already rare, there are complications surrounding pin placement during navigated total hip replacement such as additional wound site infection, persistent local tenderness, periprosthetic fracture, and retained bony debris appearing in postoperative films, which are readily reported in the literature [ [4] , [5] , [6] , [7] ].…”

Retained pelvic pin site debris after navigated total hip replacement

“…As with the adoption of any new technology-assisted approach, the uptake of navigated THR[ 6 ] has heralded a new suite of technique-specific potential complications. [ 7 8 ] One such example—not usually seen with conventional instrumented THRs—relates to fixed-array pelvic trackers. This report describes the unusual circumstance of retained bony debris generated from self-drilling, self-tapping iliac crest navigation pins being misinterpreted on advanced imaging—at a hospital remote from the index surgery—as an aggressive, early-stage, chondrosarcomatous lesion.…”