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Ben Ismail I, Sghaier M, Rebii S, Manai G, Zoghlami A. Caecal perforation secondary to intrapelvic migration of a total hip prosthesis: A case report and a review of the literature. Int J Surg Case Rep 2024; 123:110217. [PMID: 39213928 PMCID: PMC11401207 DOI: 10.1016/j.ijscr.2024.110217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/20/2024] [Accepted: 08/25/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Total hip arthroplasty (THA) is commonly performed to alleviate hip pain and restore function. While generally safe, complications such as prosthesis migration can occur. Intrapelvic migration of hip prostheses, leading to bowel perforation and fistula formation, is a rare but severe complication requiring prompt diagnosis and management. This case report, presented in line with the SCARE criteria, highlights a case of caecal perforation due to hip prosthesis migration. CASE PRESENTATION A 78-year-old female with a history of right THA presented with severe hip pain, loss of function, and a persistent fistula exuding fecaloid fluid. Examination revealed fever, rigidity, and limited hip motion. CT scans showed intrapelvic protrusion of the prosthetic components and a colo-cutaneous fistula. Emergency laparotomy revealed caecal perforation by a screw from the acetabular component, necessitating resection of the perforated caecum. A subsequent surgery addressed the hip prosthesis. The patient recovered uneventfully and was discharged on day 7. DISCUSSION Prosthesis migration into the pelvis is a serious complication of THA. Risk factors include implant loosening, acetabular bone loss, surgical technique issues, and patient factors like obesity and osteoporosis. Diagnosis relies on imaging studies. Management typically involves surgical removal of the migrated prosthesis and repair of the perforation, necessitating a multidisciplinary approach. CONCLUSION Caecal perforation due to intrapelvic migration of a hip prosthesis is rare but potentially life-threatening. Prompt diagnosis and appropriate management are crucial. Further research is needed to better understand risk factors and prevention strategies.
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Affiliation(s)
- Imen Ben Ismail
- Department of General Surgery, Traumatology and Great Burns Center, Ben Arous, Tunisia; University of Tunis el Manar, Faculty of Medicine of Tunis.
| | - Marwen Sghaier
- Department of General Surgery, Traumatology and Great Burns Center, Ben Arous, Tunisia; University of Tunis el Manar, Faculty of Medicine of Tunis
| | - Saber Rebii
- Department of General Surgery, Traumatology and Great Burns Center, Ben Arous, Tunisia; University of Tunis el Manar, Faculty of Medicine of Tunis
| | - Ghazi Manai
- Department of General Surgery, Traumatology and Great Burns Center, Ben Arous, Tunisia; University of Tunis el Manar, Faculty of Medicine of Tunis
| | - Ayoub Zoghlami
- Department of General Surgery, Traumatology and Great Burns Center, Ben Arous, Tunisia; University of Tunis el Manar, Faculty of Medicine of Tunis
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2
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Stofferin H, Gmeiner R, Pfitscher K, Hörmann R, Thaler M. The Anatomical Course of the Superior Gluteal Vessel Bundle with Regard to Different Approaches in Total Hip Arthroplasty. J Arthroplasty 2024; 39:1088-1092. [PMID: 37918488 DOI: 10.1016/j.arth.2023.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Iatrogenic vascular injury during total hip arthroplasty (THA) is rare, reported at rates of 0.05 to 0.3%, but a potentially limb-threatening and life-threatening complication. We aimed to describe safe and danger zones for the superior gluteal vessel bundle (SGV bundle) with reference to different THA approaches. METHODS There were 27 formalin-fixed cadavers with 49 hemipelves dissected. The course and distribution of the SGV bundle were investigated with the help of anatomical landmarks like the greater trochanter, the iliac tubercle (IT), and the ischial tuberosity. RESULTS We found and exposed the SGV bundle in all 49 specimens with no sex-specific differences. No SGV bundle was encountered up to 28 mm from the greater trochanter and up to 16 mm below the IT. The zone with the highest probability of finding the vessels was 25 to 65 mm below the IT in 39 (80%) cases - defining a danger zone (in relation to the skin incision) in the proximal fourth for the direct anterior approach, in the proximal half for the antero-lateral approach, in the proximal fifth for the direct lateral approach, and almost no danger zone for the posterior approach. CONCLUSIONS Special care in proximal instrument placement should be taken during THA. When extending one of the surgical approaches, manipulations in the proximal, cranial surgical window should be performed with the utmost care to avoid SGV bundle injury.
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Affiliation(s)
- Hannes Stofferin
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raphael Gmeiner
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Katharina Pfitscher
- Department of Obstetrics and Gynecology, Schwaz County Hospital, Schwaz, Austria
| | - Romed Hörmann
- Institute of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Thaler
- Arthroplasty Center, Helios Klinikum Munich West, Munich, Germany; Center for Orthopaedics, Trauma Surgery and Rehabilitation Medicine, University of Greifswald, Greifswald, Germany
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3
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Papagiannis S, Sinos G, Kotsia C, Tatani I, Megas P. Intrapelvic Cup Migration Following Revision Total Hip Arthroplasty: A Case Report and Review of the Literature. Cureus 2024; 16:e51498. [PMID: 38304679 PMCID: PMC10831581 DOI: 10.7759/cureus.51498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
Intrapelvic acetabular cup migration is a rare but serious complication that can occur following either primary or revision total hip arthroplasty. Medial acetabular wall weakening is considered the main predisposing factor for acetabular protrusion. A thorough preoperative plan is essential to advocate proper pelvic anatomy reconstruction, including osteosynthesis of the pelvis, if necessary, preservation of muscle and bone stock, and selection of the right prosthetic components without damaging adjacent anatomical structures. We present a rare case of an 84-year-old woman with a hip dislocation and complete intrapelvic migration of the acetabular component, nine years after her second revision surgery of a hip prosthesis placed 60 years ago due to congenital hip dysplasia. The protruded acetabulum was not removed since preoperative CT and digital subtraction angiography (DSA) revealed no vascular compromise. A non-cemented, tantalum acetabular cup, reinforced by a short flange titanium acetabular cage, was placed with a cemented, polyethylene-bearing surface, which was revised to a cemented, constrained acetabular insert three months postoperatively due to dislocation after mobilization on the bed. We conducted a literature review to elucidate the causes, proper diagnostic tools, and preoperative planning of this rare occurrence while trying to evaluate a potential treatment protocol.
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Affiliation(s)
| | - George Sinos
- Orthopaedics and Traumatology, Patras University Hospital, Patras, GRC
| | | | - Irini Tatani
- Orthopaedics and Traumatology, Patras University Hospital, Patras, GRC
| | - Panagiotis Megas
- Orthopaedics and Traumatology, Patras University Hospital, Patras, GRC
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Tonetti J, Martz P, Riouallon G, Boudissa M. New trends in hip and pelvic-acetabular fixation. Orthop Traumatol Surg Res 2023; 109:103698. [PMID: 37797806 DOI: 10.1016/j.otsr.2023.103698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Jerome Tonetti
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital A. Michallon, CS 10217, 38043 Grenoble cedex 9, France.
| | - Pierre Martz
- Service de chirurgie orthopédique et traumatologique, hôpital F. Mitterrand, BP 77908, 14, rue Paul-Gaffarel, 21079 Dijon, France
| | - Guillaume Riouallon
- Service de chirurgie orthopédique et traumatologie, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, France
| | - Mehdi Boudissa
- Clinique universitaire de chirurgie orthopédique et traumatologie, hôpital A. Michallon, CS 10217, 38043 Grenoble cedex 9, France
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5
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Diesel CV, Guimarães MR, Menegotto SM, Pereira AH, Pereira AA, Bertolucci LH, Freitas EC, Galia CR. Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants. Bone Jt Open 2022; 3:859-866. [DOI: 10.1302/2633-1462.311.bjo-2021-0188.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. Conclusion The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients. Cite this article: Bone Jt Open 2022;3(11):859–866.
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Affiliation(s)
- Cristiano V. Diesel
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcelo R. Guimarães
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Samuel M. Menegotto
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Adamastor H. Pereira
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Alexandre A. Pereira
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Leonardo H. Bertolucci
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduarda C. Freitas
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carlos R. Galia
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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6
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Shigemura T, Murata S, Murata Y. Prophylactic placement of external iliac artery balloon catheter in a patient with intrapelvic prosthesis migration after hemiarthroplasty: A case report. J Clin Orthop Trauma 2022; 28:101846. [PMID: 35378775 PMCID: PMC8976146 DOI: 10.1016/j.jcot.2022.101846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
Intrapelvic prosthesis migration is a rare but serious complication of bipolar hemiarthroplasty in femoral neck fractures. The external iliac artery is one of the most frequently damaged arteries during the removal of a migrated implant from the pelvic region. This report describes a case in which prophylactic placement of an external iliac artery balloon catheter was performed to reduce blood loss in the event of vascular injury during implant removal surgery in the pelvic region.
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Affiliation(s)
- Tomonori Shigemura
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
- Corresponding author.
| | - Satoru Murata
- Department of Interventional Radiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
| | - Yasuaki Murata
- Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan
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Sculco PK, Wright T, Malahias MA, Gu A, Bostrom M, Haddad F, Jerabek S, Bolognesi M, Fehring T, Gonzalez DellaValle A, Jiranek W, Walter W, Paprosky W, Garbuz D, Sculco T, Abdel M, Boettner F, Benazzo F, Buttaro M, Choi D, Engh CA, Garcia-Cimbrelo E, Garcia-Rey E, Gehrke T, Griffin WL, Hansen E, Hozack WJ, Jones S, Lee GC, Lipman J, Manktelow A, McLaren AC, Nelissen R, O’Hara L, Perka C, Sporer S. The Diagnosis and Treatment of Acetabular Bone Loss in Revision Hip Arthroplasty: An International Consensus Symposium. HSS J 2022; 18:8-41. [PMID: 35082557 PMCID: PMC8753540 DOI: 10.1177/15563316211034850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 11/21/2022]
Abstract
Despite growing evidence supporting the evaluation, classification, and treatment of acetabular bone loss in revision hip replacement, advancements have not been systematically incorporated into a single document, and therefore, a comprehensive review of the treatment of severe acetabular bone loss is needed. The Stavros Niarchos Foundation Complex Joint Reconstruction Center at Hospital for Special Surgery held an Acetabular Bone Loss Symposium on June 21, 2019, to answer the following questions: What are the trends, emerging technologies, and areas of future research related to the evaluation and management of acetabular bone loss in revision hip replacement? What constitutes the optimal workup and management strategies for acetabular bone loss? The 36 international experts convened were divided into groups, each assigned to discuss 1 of 4 topics: (1) preoperative planning and postoperative assessment; (2) implant selection, management of osteolysis, and management of massive bone loss; (3) the treatment challenges of pelvic discontinuity, periprosthetic joint infection, instability, and poor bone biology; and (4) the principles of reconstruction and classification of acetabular bone loss. Each group came to consensus, when possible, based on an extensive literature review. This document provides an overview of these 4 areas, the consensus each group arrived at, and directions for future research.
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Affiliation(s)
- Peter K. Sculco
- Hospital for Special Surgery, New York, NY, USA,Peter K. Sculco, MD, Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021, USA.
| | | | | | - Alexander Gu
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | | | - Fares Haddad
- University College London Hospitals NHS Foundation Trust and Institute of Sport, Exercise & Health, London, UK
| | | | | | | | | | | | - William Walter
- Royal North Shore Hospital, St. Leonards, NSW, Australia
| | - Wayne Paprosky
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Donald Garbuz
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
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8
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Vascular Injuries During Hip and Knee Replacement. Orthop Clin North Am 2022; 53:1-12. [PMID: 34799015 DOI: 10.1016/j.ocl.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Vascular injuries associated with hip and knee arthroplasty are rare but can result in devastating outcomes for the patient. A sound knowledge of vascular anatomy, potential mechanisms of injury, and diagnosis and management of vascular injuries are vital to an arthroplasty surgeon. Identifying high-risk patients and procedures allows careful preoperative planning, which combined with meticulous intraoperative technique, may help avoid vascular complications. When vascular injuries do occur, early recognition and intervention are critical to an improved outcome.
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9
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Ocak Karatas SF, Beyhan M, Yildiz MI, Gokce E. Mechanic ileus due to retroperitoneal migration of total hip prosthesis; A case report. Niger J Clin Pract 2021; 24:1855-1858. [PMID: 34889797 DOI: 10.4103/njcp.njcp_697_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Intrapelvic migration of total hip prosthesis is a rare but severe complication of total hip arthroplasty that can cause severe outcomes for elderly patients. A 78-year-old female patient was referred to our hospital with the complaint of no gas-stool excretion for 3-4 days, abdominal distension, nausea, vomiting, and a preliminary diagnosis of ileus. Computed tomography showed the migration of the left total hip prosthesis to the pelvis, causing a hematoma around the prosthesis and mechanical ileus due to the compression of the hematoma. To our knowledge, this case report is the only reported mechanic ileus due to migration of total hip prosthesis. Although postop paralytic ileus is one of the complications of total hip arthroplasty, mechanical ileus has not been described before. This case report shows that mechanical ileus might be an unreported complication of total hip arthroplasty. It should be kept in mind that mechanical ileus complications may also occur after hip arthroplasty.
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Affiliation(s)
| | - M Beyhan
- Department of Radiology, Tokat Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
| | - M I Yildiz
- Department of General Surgery, Tokat State Hospital, Tokat, Turkey
| | - E Gokce
- Department of Radiology, Tokat Gaziosmanpaşa University, Faculty of Medicine, Tokat, Turkey
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10
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Revision Hip Arthroplasty in Patient with Acetabulum Migration into Subperitoneal Space-A Case Report. ACTA ACUST UNITED AC 2020; 57:medicina57010030. [PMID: 33396344 PMCID: PMC7824657 DOI: 10.3390/medicina57010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/20/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022]
Abstract
Revision hip arthroplasty procedures have been extensively discussed in the literature. At the same time, discussions of the management of acetabular component protrusion into the pelvic cavity, and, more specifically, the subperitoneal space, necessitating an additional abdominal approach for the revision arthroplasty, have only been published as case reports and descriptions of transperitoneal approaches have been even rarer. This paper presents the case of a 63-year-old female patient in whom a peritoneal approach was necessary to access a migrated acetabular component. The outcome of the treatment, which represented a complex orthopedic and general surgical problem, was good. We believe that the complexity of revision hip arthroplasty in patients with protrusion of the acetabular component together with the head and proximal part of the stem of the implant into subperitoneal space calls for a careful re-analysis of the category of Type III bony acetabulum defects according to Paprosky, where the recognition of two subtypes would facilitate analysis of such cases.
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11
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Zanasi S, Zmerly H. Customised three-dimensional printed revision acetabular implant for large defect after failed triflange revision cup. BMJ Case Rep 2020; 13:13/5/e233965. [PMID: 32457031 PMCID: PMC7253004 DOI: 10.1136/bcr-2019-233965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aseptic loosening is the most common cause for total hip arthroplasty revision. Acetabular cup revision is a significant challenge in the presence of a large bone defect. One of the options for cup revision in the presence of a large bone defect is the recently introduced customised three-dimensional (3D)-printed reconstruction. We present the case of a 68-year-old woman successfully treated with a customised revision acetabular implant for the failure of triflange cup in the presence of large acetabular defect. The modern orthopaedic surgeon must have full knowledge of customised 3D-printed reconstruction to have as a reserve solution for difficult hip revision surgery.
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Affiliation(s)
- Stefano Zanasi
- Hesperia Hospital, Modena, Emilia-Romagna, Italy.,University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Hassan Zmerly
- San Pier Damiano Hospital, Faenza, RA, Italy .,UCM (MT), LUDES, Lugano, Switzerland
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12
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Internal iliac artery injury due to intrapelvic migration of infected acetabular reconstruction cage with hook: A case report. J Orthop Sci 2020; 25:201-204. [PMID: 28755797 DOI: 10.1016/j.jos.2017.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 06/29/2017] [Accepted: 07/10/2017] [Indexed: 11/21/2022]
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13
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Shahait AD, Chagas C, Hussein S, Bhat Z. Unique case of delayed external iliac artery pseudoaneurysm after a remote total hip arthroplasty. BMJ Case Rep 2019; 12:e226661. [PMID: 31088810 PMCID: PMC6536214 DOI: 10.1136/bcr-2018-226661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 11/04/2022] Open
Abstract
Vascular intrapelvic complications due to total hip arthroplasty failure are uncommon, with less than 30 cases reported in the literature. Herein, we report a case of unusual asymptomatic delayed vascular complication after 10 years from right total hip arthroplasty. A man in mid-50s, with multiple comorbidities including end-stage renal disease. The patient was admitted for the renal transplant surgery. Intraoperatively, right external iliac artery pseudoaneurysm was discovered, which required the transplantation to be done on the left side. After recovery from the renal transplant surgery, the patient underwent resection of the right external iliac artery pseudoaneurysm with primary anastomosis by vascular surgery, with resection of the migrated screw by orthopaedic surgery.
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Affiliation(s)
- Awni D Shahait
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Cristian Chagas
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Shakir Hussein
- Department of Surgery, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Zeenat Bhat
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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14
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Abdelnasser MK, Khalifa AA, Khalifa YE, Bakr HM, Mahran MA, Moustafa MA, Mohammad AK, Abdelaal AM. The use of pararectus approach for Type 3B Paprosky acetabular defect with intrapelvic cup migration. Case report. SICOT J 2019; 5:11. [PMID: 30931898 PMCID: PMC6442451 DOI: 10.1051/sicotj/2019008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 02/28/2019] [Indexed: 12/01/2022] Open
Abstract
Case: A case of Type 3B Paprosky acetabular defect with intrapelvic cup migration where anterior column plating and cup extraction was done through an abdominal pararectus approach. A male patient 63 years old reported progressive pain and walking disability after five years of cementless THR for right hip AVN. CT pelvis showed loose intrapelvic migrated cup, extensive osteolytic acetabular defects, and pelvic discontinuity. Pararectus approach was used to remove the cup and the head with concomitant plating of the anterior column Conclusion: The pararectus approach is a valid option for intrapelvic cup extraction and pelvic discontinuity fixation.
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Affiliation(s)
| | - Ahmed A Khalifa
- Orthopedic Department, Qena University Hospital, Qena, Egypt
| | - Yaser E Khalifa
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | - Hatem M Bakr
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
| | | | | | - Ayman K Mohammad
- General Surgery Department, Assiut University Hospital, Assiut, Egypt
| | - Ahmed M Abdelaal
- Orthopedic Department, Assiut University Hospital, Assiut, Egypt
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15
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Stickney W, Yoon RS, Patel JN, Klein DS, Haiduekwych GJ, Liporace FA. Intrapelvic component retrieval via anterior inferior iliac spine osteotomy in revision total hip arthroplasty. Hip Int 2019; 29:222-225. [PMID: 30421636 DOI: 10.1177/1120700018812128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION: In the revision setting, intrapelvic acetabular components provide a unique set of challenges for the treating surgeon. Retrieval is complicated by complex anatomical relationships within the pelvis and historically, surgeons have used multiple approaches to safely retrieve the cup. CASE PRESENTATION: We present the case of a 53-year-old female with intrapelvic migration of the acetabular components of her total hip arthroplasty. Patient was treated through a novel, single incision approach with utilisation of an anterior inferior iliac spine (AIIS) osteotomy. RESULTS: An AIIS osteotomy allows for improved visualisation within the pelvis and safe retrieval through a single exposure without compromising the ability to perform definitive, revision reconstruction. At 1-year follow-up, the patient has had no complications related to infection or failure of the implants. Ambulation is performed with the aid of a cane in the community with mild, occasional pain.
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Affiliation(s)
- William Stickney
- 1 Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Richard S Yoon
- 1 Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - Jay N Patel
- 1 Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - David S Klein
- 1 Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
| | - George J Haiduekwych
- 2 Department of Orthopaedic Surgery, Division of Orthopaedic Trauma & Complex Adult Reconstruction, Orlando Regional Medical Center, Orlando, FL, USA
| | - Frank A Liporace
- 1 Department of Orthopaedic Surgery, Division of Orthopaedic Trauma and Complex Adult Reconstruction, Jersey City Medical Center - RWJBarnabas Health, Jersey City, NJ, USA
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Papaioannou I, Ntourantonis D, Baikousis A, Syrimpeis V, Korovessis P. Unique Migration of a Septic Loosened Metal-on-metalCementless Total Hip Arthroplasty: A Case Report and Literature Review. J Orthop Case Rep 2019; 10:93-97. [PMID: 32547989 DOI: 10.13107/jocr.2019.v10.i01.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Total hip arthroplasty (THA) is one of the most successful and cost- effective surgical procedures developed during the last century. Although, chronic infection accompanied with granulomatous allergic reaction from Cobalt (Co),Chromium (Cr) debris after metal-on-metal (MoM) THA implantation can cause severe osteolysis, with subsequent loosening and migration of the implants. There are many cases with intrapelvic migration of these implants, however to best of our knowledge, there is no report of a complete horizontal migration (on frontal plane) of the whole THA prosthesis without disassembly accompanied with severe bone destruction. Case Report A 52-year-old female patient was admitted to the authors' department with inability to weight bear. Because of bilateral developmental hip dysplasia (Type II, Hartofilakidis classification) she underwent THA bilaterally at another institution about 20 years ago. On admission, the initial plain roentgenogram of the hip was impressive, disclosing sclerotic, osteolytic lesions, associated with perforation of the lateral and medial cortices of the proximal femur, and migration to 90-degree horizontal position on the frontal plane of the whole prosthesis. Based on the preoperative planning, the implants were removed through a small medial longitudinal approach accompanied with lateral debridement. The patient denied revision surgery and the final result was a resection arthroplasty. Conclusion THA is one of the most clinically successful surgical procedures, although inappropriate patient or implant selection for primary hip arthroplasty can lead to the necessity of complex revision surgery after late-diagnosed postoperative complications such as infection, loosening, and migration of the prosthesis. A well-designed preoperative plan is mandatory when handling such cases. Clinicians when faced with THA migration, rare or common, should definitely rule out the infection. Adverse reactions to metal debris (ARMD) can also lead to significant displacement of a hip prosthesis, although coexistence of metallosis and infection cannot be excluded in advance.
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Asemota D, Passano B, Feng JE, Novikov D, Anoushiravani AA, Schwarzkopf R. Preoperative optimization for vascular involvement complicating revision total hip arthroplasty. Arthroplast Today 2018; 4:411-416. [PMID: 30560168 PMCID: PMC6287237 DOI: 10.1016/j.artd.2018.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/30/2022] Open
Abstract
Vascular complications in revision total hip arthroplasty may occur in cases where the components of the hip implant migrate through the acetabular wall, through the iliopectineal line of the pelvis, and into the pelvic cavity. This migration may lead to substantial intrapelvic vascular compromise, drastically increasing the surgical complexity and potential risk for morbidity and mortality in these surgical cases. Here, we present a case of a 78-year-old woman with significant acetabular protrusio, which resulted in intraoperative compromise of the external iliac artery with rapid extravasation. As a result of prudent preoperative planning, interdisciplinary collaboration, and precautionary measures, significant patient morbidity and mortality was averted. Level of Evidence Level V, Case Report.
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Affiliation(s)
- Daniel Asemota
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - Brandon Passano
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - James E Feng
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - David Novikov
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - Afshin A Anoushiravani
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
| | - Ran Schwarzkopf
- Division of Adult Reconstructive Surgery, NYU Langone Orthopedics, NYU Langone Health, New York, NY, USA
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Stoppa approach for intrapelvic migration of lag screw for proximal femoral nail. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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A modified iliofemoral approach to intrapelvic acetabular revision – technical note. REVISTA BRASILEIRA DE ORTOPEDIA (ENGLISH EDITION) 2018; 53:656-659. [PMID: 30258834 PMCID: PMC6152800 DOI: 10.1016/j.rboe.2017.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/01/2017] [Indexed: 11/23/2022]
Abstract
Among the patterns of acetabular osteolysis associated with acetabular loosening, the authors emphasize the severity of pelvic dissociation and medial segmental losses in which the quadrilateral lamina is severely affected. Such lesions are potentially lethal in cases of large vascular injury. This note aimed to describe a modified iliofemoral approach in cases of massive intrapelvic migration of the acetabular component in patients with total proximity of the iliac vascular bundle and absence of an anatomical demarcation plane between the migrated contents and the iliac bundle. This approach was performed in 12 of 21 patients who had these criteria.
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Vicente JRN, Miyahara HDS, Ejnisman L, Souza BDB, Gurgel HM, Croci AT. Acesso iliofemoral modificado para revisão de componente acetabular intrapélvico – nota técnica. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Murcia-Asensio A, Ferrero-Manzanal F, Lax-Pérez R, Suárez-Suárez MA, Salmerón-Martínez EJ. Acute intrapelvic cup migration: advantages of adyuvant Stoppa approach for implant removal/reconstruction. A case report. J Orthop 2017; 14:336-339. [PMID: 28579700 DOI: 10.1016/j.jor.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/14/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Antonio Murcia-Asensio
- Hospital General Universitario Reina Sofía, Avda. Intendente Jorge Palacios, 1, 30003, Murcia, Spain), Spain
| | - Francisco Ferrero-Manzanal
- Hospital General Universitario Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Santa Lucía, Cartagena, Spain
| | - Raquel Lax-Pérez
- Hospital General Universitario Reina Sofía, Avda. Intendente Jorge Palacios, 1, 30003, Murcia, Spain), Spain
| | - Miguel Angel Suárez-Suárez
- Hospital General Universitario Reina Sofía, Avda. Intendente Jorge Palacios, 1, 30003, Murcia, Spain), Spain.,Hospital General Universitario Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Santa Lucía, Cartagena, Spain.,Hospital Universitario de Cabueñes, Calle Los Prados, 395, 33394 Gijón, Asturias, Spain.,Hospital Morales Meseguer, Av Marqués de los Vélez, s/n, 30008 Murcia, Spain
| | - Emilio José Salmerón-Martínez
- Hospital General Universitario Reina Sofía, Avda. Intendente Jorge Palacios, 1, 30003, Murcia, Spain), Spain.,Hospital General Universitario Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Santa Lucía, Cartagena, Spain.,Hospital Universitario de Cabueñes, Calle Los Prados, 395, 33394 Gijón, Asturias, Spain.,Hospital Morales Meseguer, Av Marqués de los Vélez, s/n, 30008 Murcia, Spain
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Subperitoneal approach in revision arthroplasty for acetabular component protrusion: Analysis of practices within the French Hip and Knee Society (SFHG). Orthop Traumatol Surg Res 2017; 103:27-31. [PMID: 27876582 DOI: 10.1016/j.otsr.2016.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 10/03/2016] [Accepted: 10/25/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The complications related to revision for acetabular component protrusion with material migrating into the intrapelvic region remain rare but potentially serious. Today, the literature reports no epidemiological data on the subperitoneal approach (SPA) in revision total hip arthroplasty (RTHA) for protrusion. Therefore we conducted a retrospective study on a large revision arthroplasty database to answer the following questions: (1) What is the frequency of this approach in this population? (2) What are the factors related to this procedure? (3) Is morbidity and mortality of the SPA higher than for an isolated conventional approach? HYPOTHESIS Major protrusions with material in the superomedial quadrant (SMQ) have a higher probability of being operated using a SPA. MATERIAL AND METHODS This multicenter retrospective study included 260 cases of THA with endopelvic protrusion of material at least 15mm inside the Kohler line. The degree of protrusion was assessed on the AP pelvic X-ray with the construction of the SMQ. The reason for the subperitoneal approach, the duration of surgery, and the preoperative exams were also collected. RESULTS Nineteen procedures out of the 260 RTHAs included (7.8%) had a SPA in addition to the approach for the revision THA. The frequency of the SPA varied among centers (range: 1.7-50%). In four cases, the SPA was indicted to care for a vascular complication identified preoperatively. For one patient, the SPA was indicated intraoperatively. The other indications were either to extract the implant (n=7) or prevent a potential intraoperative assault of neurovascular structures (n=9). The cases presenting major protrusion on the AP X-ray with material in the SMQ were more often operated through the SPA (12/19; 63.2%) than cases with no SMQ involvement (4/241; 1.7%) (P<0.001). Vascular structures were explored with imaging in 15 out of 19 (88.9%) of the SPA cases versus 26 out of 177 (14.7%) of the revisions without the SPA (41 with no information in the non-SPA group) (P<0.001). Early mortality (before 45 days) of patients who had undergone the SPA (1/19; 5.3%) was not significantly different than for the patients who had not undergone the SPA (3/241; 1.2%) (P=0.26). Although the duration of surgery was longer in the SPA group (210±88 [range: 70-360] versus 169±52 [range: 60-300]; P=0.04), bleeding was not greater in the SPA group (1488±1770mL [range: 500-5000mL]) than in the non-SPA group (1343±987mL [range: 75-3500mL]; p>0.05). DISCUSSION Despite the limitations related to the retrospective and multicenter design of this study, to our knowledge it is the only one that examines SPA procedures within the context of severe material protrusion with THA. Based on these results, it seems preferable to plan for SPA every time there is an acetabular protrusion in the SMQ, after exploration with CT angiography. The SPA does not result in greater mortality or morbidity. LEVEL OF EVIDENCE IV, retrospective study.
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Safe zone for transacetabular screw fixation using a Kerboull cross-plate: A CT-scan templating prospective study. Orthop Traumatol Surg Res 2016; 102:1017-1022. [PMID: 27810321 DOI: 10.1016/j.otsr.2016.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/09/2016] [Accepted: 09/01/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Implantation of Kerboull acetabular reinforcement cross-plates (Kerboull plate) carries a risk for injury to vascular structures and pelvic organs. To our knowledge, there is no study assessing anatomical assessment related to this risk with this specific design. Therefore, we performed a prospective study to answer the following four questions: 1) What is the minimum distance and angle between the plate and iliac vessels? 2) What is the distance between the plate and the inner cortex of the ilium? 3) What is the ratio of views with muscle tissue present on the inner surface of the ilium? 4) What are the boundaries of the safe zone for transacetabular screw fixation for a Kerboull plate? HYPOTHESIS A safe zone for fixation screws would be defined by a narrow range of insertion angles. MATERIALS AND METHODS This is a CT-based 3D templating prospective study. Simulations were performed for 18 patients fitted with a Kerboull plate. An original Kerboull plate (Stryker, Mahwah, NJ, USA) was placed at a 45° abduction angle relative to the X-axis (alignment A) and the palette was placed vertically to the X-axis (alignment B). We measured the distance from the centre of the plate to the inner surface of the cortex of the ilium, the shortest distance to vessels and the angle of existing vessels, and the ratio of muscles on the inner surface of the ilium. RESULTS The shortest distance to the vascular structures increased with increasing angle of insertion of the fixation screws, 85.8±12.1mm for A and 111.4±12.0mm for B at 45°. The distance to the inner cortex was further increased for screws inserted in posterior direction. At insertion angles ≥40°, the screws passed through muscle before invading the pelvis in most cases. However, at anterior-posterior angle (AP angles) ≤-10°, the risk of direct insertion of screws into the sacroiliac joint increased. DISCUSSION The safe zone for transacetabular screws would be insertion at an angle≥40°, with an AP angle between 0° and -10° (slight posterior direction). LEVEL OF EVIDENCE Level IV prospective diagnostic study.
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Murcia-Asensio A, Ferrero-Manzanal F, Lax-Pérez R, Fernández-Fairén M. Stoppa approach for intrapelvic damage control and reconstruction of complex acetabular defects with intra-pelvic socket migration: A case report. Int J Surg Case Rep 2016; 25:143-8. [PMID: 27372028 PMCID: PMC4932486 DOI: 10.1016/j.ijscr.2016.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/28/2022] Open
Abstract
A novel surgical technique for reconstructing pelvic defects in hip revision surgery is described. The Stoppa approach allows for pelvic damage control and reconstruction of bone defect. The bone reconstruction is made by combining an intrapelvic plating with augmented socket reconstruction.
Introduction Failed hip arthroplasty with intrapelvic acetabular migration can be challenging due to the potential damage of intrapelvic structures. Presentation of the case We present a case of a 75 year-old lady with failed hip arthroplasty with loosening of implants and intra-pelvic migration of the cup, antiprotrusio cage mesh, screws and plate. A modified Stoppa approach was performed, a part of the migrated elements were safely removed, the intrapelvic structures were controlled, and the bone defect was reconstructed through the Stoppa approach combined with the lateral window of ilioinguinal approach by means of bone struts and metallic plates, which is a novel technique. Then an extended posterolateral hip approach was done and the acetabulum was reconstructed using porous tantalum augments and morselized allograft. A cemented constrained socket was implanted. After one-year follow-up the patient is able to walk with one crutch without pain. Discussion Due to intrapelvic migration, the implants used in hip arthroplasty may become entrapped between the anatomical structures lodged in the pelvis and cause damage to them. A careful preoperative assessment and planning are mandatory. A migrated socket can be inaccessible through a conventional hip approach and removal could be very difficult and dangerous. Conclusion The Stoppa approach in hip revision surgery can be a complement to traditional approaches to control the intrapelvic structures, remove migrated implants of previous surgery and reconstruct the pelvic defect.
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Affiliation(s)
- Antonio Murcia-Asensio
- Hospital General Universitario Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Santa Lucía, Cartagena, Spain.
| | - Francisco Ferrero-Manzanal
- Hospital General Universitario Santa Lucía, C/Mezquita, s/n, Paraje Los Arcos, 30202, Santa Lucía, Cartagena, Spain.
| | - Raquel Lax-Pérez
- Hospital General Universitario Reina Sofía, Avda. Intendente Jorge Palacios, 1, 30003 Murcia, Spain.
| | - Mariano Fernández-Fairén
- Instituto de Cirugía Ortopédica y Traumatología deBarcelona, C/Diputación, 321-Pral. 2º Les Corts, 08029 Barcelona, Spain.
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Extraction of hip arthroplasty for intrapelvic migration by pararectus-abdominis approach in an elderly patient. CURRENT ORTHOPAEDIC PRACTICE 2016. [DOI: 10.1097/bco.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alshameeri Z, Bajekal R, Varty K, Khanduja V. Iatrogenic vascular injuries during arthroplasty of the hip. Bone Joint J 2015; 97-B:1447-55. [DOI: 10.1302/0301-620x.97b11.35241] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vascular injuries during total hip arthroplasty (THA) are rare but when they occur, have serious consequences. These have traditionally been managed with open exploration and repair, but more recently there has been a trend towards percutaneous endovascular management. We performed a systematic review of the literature to assess if this change in trend has led to an improvement in the overall reported rates of morbidity and mortality during the last 22 years in comparison with the reviews of the literature published previously. We found a total of 61 articles describing 138 vascular injuries in 124 patients. Injuries because of a laceration were the most prevalent (n = 51, 44%) and the most common presenting feature, when recorded, was bleeding (n = 41, 53.3%). Delay in diagnosis was associated with the type of vascular lesion (p < 0.001) and the clinical presentation (p = 0.002). Open exploration and repair was the most common form of management, however percutaneous endovascular intervention was used in one third of the injuries and more constantly during the last 13 years. The main overall reported complications included death (n = 9, 7.3%), amputation (n = 2, 1.6%), and persistent ischaemia (n = 9, 7.3%). When compared with previous reviews there was a similar rate of mortality but lower rates of amputation and permanent disability, especially in patients managed by endovascular strategies. Cite this article: Bone Joint J 2015;97-B:1447–55.
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Affiliation(s)
- Z. Alshameeri
- Addenbrooke’s, Cambridge University Hospitals
NHS Trust, Box 37, Hills
Road, Cambridge CB2 0QQ, UK
| | - R. Bajekal
- Barnet Hospital, Royal
Free Hospital NHS Foundation Trust, Hertfordshire, UK
| | - K. Varty
- Addenbrooke’s, Cambridge University Hospitals
NHS Trust, Box 37, Hills
Road, Cambridge CB2 0QQ, UK
| | - V. Khanduja
- Addenbrooke’s, Cambridge University Hospitals
NHS Trust, Box 37, Hills
Road, Cambridge CB2 0QQ, UK
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Epinette JA, Mertl P, Combourieu B, Goncalves H, Blairon A, Ehlinger M, Tabutin J. Outcomes and prognostic factors in revision hip arthroplasty for severe intra-pelvic cup protrusion: 246 cases. Orthop Traumatol Surg Res 2015; 101:S257-63. [PMID: 26320392 DOI: 10.1016/j.otsr.2015.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 06/21/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND The outcome of revision total hip arthroplasty (THA) for intra-pelvic cup protrusion is unclear. Hence, we conducted a large retrospective study to clarify the surgical strategy (hip lever arm and cup mechanical fixation) and the outcomes of reconstruction for severe intra-pelvic cup protrusion. HYPOTHESIS We hypothesized that restoration of the anatomic hip centre in such acetabular revisions decreased the risk of recurrent loosening. MATERIAL AND METHODS The study included 246 THA procedures (in 220 patients), with a follow-up of 5.2 ± 4.9 years (1-24.2) after the index surgery. Bone loss was estimated using the SOFCOT classification (grade III or IV in 80% of cases) and the Paprosky classification (IIIA or IIIB in 58% of cases). Quality of the reconstruction was assessed on X-rays according to the correction of the protrusion and position of the hip centre of rotation. RESULTS After a clinical follow-up of at least 5 years, with a mean of 9.9 ± 4.1 years (5-24 years), the mean Postel-Merle d'Aubigné score was 14.2 ± 3.1 and the mean Harris Hip Score was 78.0 ± 18.7. Cup protrusion was partially or completely corrected in every case and cup position was normal in 27 (11%) cases. The centre of rotation was within 10mm of the physiological position in 158 (64.2%) cases, acceptable in 77 (31.3%) cases, ascended in 9 (3.7%) cases, and worsened in 1 (0.4%) case. Revision for cup or cup and femoral failures was required in 24 (9.8%) cases. Cumulative survival rates with cup loosening as the endpoint were 88.5% after 5 years, 79.9% after 10 years, and 63.9% at last follow-up at 13.6 years. DISCUSSION Our hypothesis that restoration of anatomic hip centre decreased the risk of recurrent loosening was not verified: success or failure in restoring the normal centre of rotation did not correlate significantly with final cup status. Recurrent aseptic loosening was the cause of failure in 9.8% of cases. Ensuring long-term effective mechanical stability had a greater impact on global outcomes than restoring an ideal centre of rotation.
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Affiliation(s)
- J-A Epinette
- Clinique Médico-Chirugicale, 200, rue d'Auvergne, 62700 Bruay-Labuissière, France.
| | - P Mertl
- Service de Chirurgie Orthopédique et Traumatologique, CHU d'Amiens, Hôpital Nord, 1, place Victor-Pauchet, 80054 Amiens, France
| | - B Combourieu
- Hôpital Raymond-Poincaré, Département universitaire de Chirurgie Orthopédique et de Traumatologie, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - H Goncalves
- Hôpital Raymond-Poincaré, Département universitaire de Chirurgie Orthopédique et de Traumatologie, 104, boulevard Raymond-Poincaré, 92380 Garches, France
| | - A Blairon
- Département universitaire de Chirurgie Orthopédique et de Traumatologie, Université Lille Nord de France, Hôpital Salengro, CHRU de Lille, place de Verdun, 59037 Lille, France
| | - M Ehlinger
- Service de chirurgie orthopédique et de traumatologie, Hôpital de Hautepierre, Hôpitaux universitaires de Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - J Tabutin
- Service de Chirurgie Orthopédique et de Traumatologie, Centre Hospitalier de Cannes, 15, avenue des Broussailles, 06401 Cannes, France
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Morrison R, Adegbola S, Bhattacharya V. Intra-abdominal removal of a displaced hip prosthesis. Int J Surg Case Rep 2014; 6C:12-4. [PMID: 25506842 PMCID: PMC4334883 DOI: 10.1016/j.ijscr.2014.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 06/30/2014] [Accepted: 07/05/2014] [Indexed: 11/25/2022] Open
Abstract
Laparotomy and removal of the prosthetic head is possible and preferred in some cases where further damage to the iliac bone may be caused by removal via a usual exterior approach. A sound planning strategy should be made with CT, ultrasound or laparoscopy. Retroperitoneal surgery has been described but intraperitoneal surgery is also a possibility. A good knowledge of pelvic organs and vessels is essential. Combined surgery with vascular surgeons is recommended.
INTRODUCTION Intra-pelvic displacement of hip prostheses is an uncommon complication following arthroplasty surgery but can have significant detrimental effects on the patient. We present a case of a displaced hip prosthesis into the pelvic cavity and highlight the importance of pre-operative planning and investigation as well as choosing a suitable surgical approach. PRESENTATION OF CASE A 69 year old lady with developmental dysplasia of the hips was found to have displacement of her prosthesis into the pelvis on day three following complex uncemented total hip replacement. A subsequent combined procedure between vascular and orthopaedic surgeons was carried out, including access via a laparotomy incision to allow vision and control of the iliac vessels before removal of the prosthesis. The hip was reconstructed during the same operation using a cup cage construct, reinforced with plate fixation of the posterior column of the pelvis. DISCUSSION Intra-pelvic displacement of hip prostheses is rare and morbidity and mortality can be significant. Pre-operative imaging modalities such as CT scanning should be used to carefully delineate the anatomy. A retro-peritoneal approach has been reported, but we used a trans-abdominal approach in this case to permit greater vision and control of pelvic structures due to the significant medial displacement of the prosthesis. CONCLUSION Intra-abdominal removal of a displaced hip prosthesis is rarely performed but allows for visualisation and careful control of the pelvic structures without damaging further the pelvic wall. We recommend this approach should be performed in conjunction with a vascular surgeon.
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Affiliation(s)
- Rory Morrison
- Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK
| | - Sam Adegbola
- Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK
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Chana-Rodríguez F, Villanueva-Martínez M, Crego-Vita D, Rojo-Manaute J, Vaquero-Martín J. Stoppa approach, an alternative for total hip arthroplasty in an intra-pelvic cup. J Arthroplasty 2013; 28:198.e1-4. [PMID: 22877624 DOI: 10.1016/j.arth.2012.04.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 02/26/2012] [Accepted: 04/23/2012] [Indexed: 02/01/2023] Open
Abstract
Removal of an acetabular prosthesis that has migrated into the pelvis can be hazardous. We describe the preoperative planning and the surgical procedure for removing a severely displaced acetabular component in one patient and outline our recommendation for the use of Stoppa approach because it has advantages of simple dissection, a low complication rate, and may help in preventing life-threatening problems.
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Affiliation(s)
- Francisco Chana-Rodríguez
- Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, C/ Doctor Esquerdo, Madrid, Spain
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