Management of migrated pelvic acetabular components in THA revision
with or without vascular involvement
Authors: Şt. CRISTEA, A. PRUNDEANU, Fl. GROSEANU, S. CUCULICI, Ş. DRAGOSLOVEANU,
Orthopaedic and Trauma Surgery Clinic, St. Pantelimon Hospital – Bucharest, Romania
ABSTRACT
Purpose:
The literature describes a high rate of mortality in cases of intrapelvic acetabular component migration, which is a rare but serious complication. Our aim is to establish and propose a treatment protocol according to our results and experience.
Material and Methods:
We performed eight (8) total hip revisions with acetabular cup migration between 2006 and 2012. A vascular graft was needed in four (4) of these cases. Two (2) cases were revisions after a spacer for infected arthroplasties. The protocol included the following: X-Ray examination (frontal and lateral views), CT angiography, a biological evaluation, a suitable pre-operative plan, at least six (6) units of blood stock, an experienced anesthesiologist, an experienced surgical team that included a vascular surgeon and a versatile arsenal of revision prostheses, bone grafts and vascular grafts. The anterolateral approach was generally used for hip revisions and the retroperitoneal approach in the dorsal decubitus position was used when vascular risk was involved.
Results:
The acetabular defect was reconstructed using bone grafts and tantalum revision cups in 4 cases, Burch-Schneider cages in 2 cases, a Kerboull ring in 1 case and a cementless oblong cup (Cotyle Espace) in 1 case. In 4 cases, an iliac vessel graft procedure was conducted by the vascular surgeon. All patients survived the revision procedures and returned regularly for subsequent check-ups, during which they did not show any septic complications.
Conclusions:
Intrapelvic acetabular cup migration is a rare but serious complication that can occur after total hip arthroplasty in either septic or aseptic cases. An experienced, multidisciplinary team of surgeons should be involved in planning and conducting such complicated revisions.
Keywords: intrapelvic acetabular cup migration, revision prosthesis, iliac vessel, protocol, multidisciplinary team of surgeons.
Level of evidence III: Retrospective cohort study series with no or a historical control group
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Intrapelvic acetabular cup migration is a serious complication especially when vascular injury happened. Management of theses complicated revisions needs an experienced, multidisciplinary team.