Treatment of protrusion of the acetabular component after total hip arthroplasty in combination with vascular surgery : a report of three cases

[SUMMARY] An acetabular component of total hip arthroplasty that protrudes into the pelvis carries a risk of injury to the iliac blood vessels during removal of the implant. We report three cases of intrapelvic migration of an acetabular component in contact with the iliac vessels. Preoperative computed tomography angiography in all cases revealed that the external /or internal iliac vessels were displaced superiomedially due to compression by the migrated cup. The implants were removed safely using a conventional hip approach in combination with release of vessels via a retroperitoneal approach in two cases, and via temporal intra-aortic balloon occlusion in one case. One of the two patients treated with a retroperitoneal approach underwent acetabular reconstruction in a consecutive surgery in a supine position through a direct anterior approach, and the other underwent reconstruction through a direct lateral approach after a postural change. For the patient who underwent intra-aortic balloon occlusion, we performed resection arthroplasty to allow a less invasive treatment. No marked intraoperative bleeding caused by injury to iliac vessels occurred in any patient, although one case required blood transfusion for oozing. These cases show that dissection of the iliac vessels via a retroperitoneal approach is safe with minimum morbidity during handling of the migrated acetabular components. A direct anterior approach can be used for acetabular revision of the protruded components without patient repositioning by combining this procedure with a retroperitoneal approach. Intra-aortic balloon occlusion is an alternative for protruded components in a case with a risk of vessel injury during dissection.

https://opac.ll.chiba-u.jp/da/curator/108249/

https://opac.ll.chiba-u.jp/da/curator/108249/S03035476-96E-3-P59.pdf

The Chiba Medical Society

千葉医学会

学術雑誌論文

AN00142148

Chiba medical journal

96E

3-4

59

65

2020-08-10

10.20776/S03035476-96E-3-P59

publisher

Chiba Medical Journal (ONLINE ISSN 2433-4235)