Retained pelvic pin site debris after navigated total hip replacement

Abstract

Once purely the domain of knee surgery, the use of computer-navigated techniques in total hip arthroplasty (THA) is becoming progressively more commonplace. As with the adoption of any new technology-assisted approach, the uptake of navigated THA utilization has heralded a new suite of technique-specific potential complications. One such example – not usually seen with conventional instrumented THA – pertains to complications related to the insertion and use of fixed pelvic array trackers. This case report describes the unusual circumstance of retained local bony debris generated through application of self-drilling, self-tapping iliac crest pins (for rigid navigation tracker placement) being mis-interpreted on advanced imaging - at a hospital site remote from the index surgery - as an aggressive, early-stage, chondrosarcomatous lesion. This case highlights the critical importance of both a general awareness of common imaging findings after navigated THA surgery (whereby tracker pins have been employed) and the value of 'hands on' clinical assessment of patients to allow correlation with suspicious imaging findings.

Advanced, Imageless Navigation in Contemporary THA: Optimising Acetabular Component Placement

“…In many cases, the system has the ability to recognise the occurrence and magnitude of pelvic positional changes, even when such movement is below the threshold of unaided surgeon perception. While many authors (and users) feel that intra-operative navigation stands as the best widely available tool for accurate cup implantation [73], such systems do have their own inherent shortcomings including a user learningcurve, system failures, loss of tracker position and poor reliability with increasing pelvic tilt [95,101]. The integration of biplanar EOS-based imaging methods with existing navigation applications (NAVEOS; VA, USA) is an exciting novel pairing [69] which has been touted to further simplify cup placement with increased 3D accuracy in a lateral decubitus position [69] however, this technology needs further, rigorous, validation before wider adoption can be championed.…”

“…Tracker pin site placement and loosening [102] continue to undermine case-bycase precision with only small positional changes resulting in magnified degradation in accuracy. As with other bony-mounted navigation applications in other parts of the body, site fractures, wound and pin site issues post-operatively also plague use and present technique-specific challenges [101].…”

Development of a non-invasive augmented reality-based navigation system for total hip arthroplasty in the supine position

“…Several concerns regarding these navigation systems have been reported [6][7][8][9]. During most navigation system procedures, xation pins must be inserted in the pelvic crest to trace pelvic movement during surgery; this prolongs surgical time and is invasive [10].…”

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] ].…”