Intrapelvic migration of total hip prostheses. Operative treatment

We describe a safe operative approach for removal of a prosthesis that has migrated into the pelvis, and we recommend that a two-stage reconstruction be done when revising the total hip-replacement arthroplasty. The first stage consists of the removal of the femoral component and cement through a lateral transtrochanteric approach, followed by removal of the acetabular component through an abdominal-retroperitoneal approach to permit exposure of the major intrapelvic structures and to ascertain their relationship to the acetabular component and cement. After the acetabular component has been removed, bone grafts are applied to the pelvis. Postoperatively, the patient is placed in traction for a time and then is allowed to walk with non-weight-bearing. The second stage of reconstruction, consisting of hip replacement, is performed nine to twelve months after the first stage. A satisfactory result was obtained in the four patients for whom we followed this operative regimen. In one patient, the first-stage procedure yielded a satisfactory result and the second stage was not done.