[Total hip arthroplasty revision surgery with migration of acetabular component to the subperitoneal space. Case report and literature review].

Abstract

Introduction: revision surgery in total hip arthroplasty associated with wear and loosening of its components has become a routine procedure. Revision arthroplasty is widely exposed in the literature. However, cases presenting with loosening and intrapelvic migration of the acetabular component are less frequent.

Clinical case: female, 82 years old, with no clinical history of importance, except for a total right hip arthroplasty cemented one month ago. The patient does not tolerate standing or sitting, and does not ambulate. MID: hip: presence of a healed wound of approximately 12 cm. Limited ranges of mobility not assessable due to pain. HHS 16 points and VAS 8/10, showing imaging studies showing intrapelvic medial migration of the acetabular component without lesion of the great vessels. Revision surgery was performed with removal of the acetabular and femoral components. Infection was ruled out using alpha-defensin. Subsequently, a bone allograft is placed in the acetabular defect, then metallic mesh over the allograft, and a tantalum wedge is placed to finally place an acetabular cup. Finally, a diaphyseal anchorage femoral stem was placed, a 28 mm femoral head with a double mobility system and reduction of prosthetic components with adequate stability with recovery of hip biomechanics.

Conclusions: the different options exposed for treatment and the combination of techniques present advantages and disadvantages. Highly porous metal cups and augmentations showed satisfactory results to correct severe defects, as is the case described, with an improvement in HHS of 64 points and VAS of 8 points one year after surgery.