Revision of migrated pelvic acetabular components in THA with or without vascular involvement

Journal of Clinical and Investigative Surgery. 2016;1(1):1-7 DOI 10.25083/2559.5555.11.17

 

Journal Homepage

Journal Title: Journal of Clinical and Investigative Surgery

ISSN: 2559-5555 (Online)

Publisher: Digital ProScholar Media

Society/Institution: Digital ProScolar media

LCC Subject Category: Medicine

Country of publisher: Romania

Language of fulltext: English

Full-text formats available: PDF

 

AUTHORS

Ștefan Cristea (Carol Davila University of Medicine and Pharmacy, Department of Orthopedics, Bucharest, Romania)
Andrei Prundeanu (St. Pantelimon Emergency Hospital, Department of Orthopedics and Trauma, Bucharest, Romania)
Florin Groseanu (St. Pantelimon Emergency Hospital, Department of Orthopedics and Trauma, Bucharest, Romania)
Ștefan Cuculici (St. Pantelimon Emergency Hospital, Department of Orthopedics and Trauma, Bucharest, Romania)
Şerban Dragosloveanu (St. Pantelimon Emergency Hospital, Department of Orthopedics and Trauma, Bucharest, Romania)
Radu Vișan (St. Pantelimon Emergency Hospital, Department of Orthopedics and Trauma, Bucharest, Romania)
Ionel Droc (Carol Davila Army Centre of Cardiovascular Diseases, Bucharest, Romania)

EDITORIAL INFORMATION

Double blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 12 weeks

 

Abstract | Full Text

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.