Total hip arthroplasty (THA) is becoming an increasingly common procedure. Although this procedure is frequently performed, intraoperative complications still arise; therefore, methods of preventing and ameliorating these complications must be devised. One such complication is the loss of the femoral trial head component within the patient.
Loss of the trial head has been documented in THA cases that have used a number of different surgical approaches.1 Although it is uncommon to lose the trial within the pelvis, it is not an entirely unlikely phenomenon. The possibility of such an event makes prevention important, especially given the associated morbidity that loss of the component could cause. Fortunately, there are preventative measures that can be taken to minimize the probability of losing the femoral trial head, in addition to techniques that can be utilized if prevention fails.
SURGICAL TECHNIQUE
PREVENTION
Firstly, it is important to avoid the use of worn-out femoral trial components. It is thought that the incidence of femoral trial head loss is increased when the trunnion is older and has been used repeatedly.2,3 Therefore, it is advised that the use of worn femoral trial stems and other older trial components be avoided.
When the femoral trial head disengages anteriorly, it has the potential to enter the pelvis/retroperitoneal space.2,4 The femoral trial head may move more freely in the absence of resistance offered by the anterior capsule.4 Therefore, when extensive anterior capsular dissection has taken place, such as during extensive capsulectomy, caution should be exercised when manipulating the hip. This emphasizes the necessity to closely monitor the head during any manipulation, particularly in the presence of significant anterior capsule disruption.
Modular hip arthroplasty prosthetics allow for various intraoperative changes to be made to the femoral component, providing greater specificity to the prosthesis.5 However, the modularity of the femoral component has been described as a factor contributing to loss of the femoral trial head.4 This also has been discussed with respect to the implantable prosthetic femoral head itself because of disengagement from the femoral stem during reduction and dislocation.4
Continue to: Case reports have cited...