2020, Number 1
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Acta Ortop Mex 2020; 34 (1)
Obturator dislocation of total hip arthroplasty with disassembly of the prosthesis components and periprosthetic fracture in morbid obese patient
Abarquero-Diezhandino A, Toro-Ibarguen AN, Moreno-Beamud JA, Ojeda-Thies C, Delgado-Diaz E
Language: English
References: 15
Page: 47-52
PDF size: 474.53 Kb.
ABSTRACT
Introduction: Anterior dislocation is a rare complication of total hip arthroplasty (THA). There exist only three cases in the literature. None of them report disassembly of the prosthesis components. We present a morbidly obese woman who suffered an irreducible obturator dislocation of an infected total hip arthroplasty (THA), due to uncontrolled adduction during an early debridement surgery. Following unsuccessful closed reduction attempts, a Vancouver B2 periprosthetic fracture and disassembly of the prosthetic components were observed. Two-stage revision THA was necessary to resolve the infection and restore hip functionality. In obturator dislocation, the femoral head prosthetic can be trapped in the obturator foramen, and this may disassemble the prosthesis components during reduction maneuvers; there’s also risk of periprosthetic fracture. This mandate an open reduction of the joint. Patient obesity could be a determining factor for this rare type of hip arthroplasty dislocation. Obturator dislocation is an extremely rare complication of the total hip arthroplasty, whose reductions should be handled with caution given the risks of periprosthetic fractures. In most cases, an open reduction of the joint is required.
Clinical importance: Our work is likely to be of great interest because it offers tips for the management of this rare complication based on our experience.
REFERENCES
Zahar A, Rastogi A, Kendoff D. Dislocation after total hip arthroplasty. Curr Rev Musculoskelet Med. 2013; 6(4): 350-6.
Epstein HC. Traumatic dislocations of the hip. Clin Orthop Relat Res. 1973; (92): 116-42.
Glassner PJ, Adler EM, Jaffe WL. Obturator dislocation of total hip arthroplasty: a case report. Bull NYU Hosp Jt Dis. 2009; 67(4): 381-3.
Day A, Duchman KR, Noiseux NO. Traumatic obturator dislocation following total hip arthroplasty managed with closed reduction: a case report and review of the literature. JBJS Case Connect. 2017; 7(3): e66.
Nicieiewski K, Banachowski W, Kowalczyk A. Obturator dislocation--a rare complication of the total hip prosthesis. Case study. Chir Narzadow Ruchu Ortop Pol. 2011; 76(5): 295-7.
Springer BD, Parvizi J, Austin M, Backe H, Della VC, Kolessar DJ, Kreuzer S, et al. Obesity and total joint arthroplasty. A literature-based review. J Arthroplasty. 2013; 28(5): 714-21.
Liu W, Wahafu T, Cheng M, Cheng T, Zhang Y, Zhang X. The influence of obesity on primary total hip arthroplasty outcomes: A meta-analysis of prospective cohort studies. Orthop Traumatol Surg Res. 2015; 101(3): 289-96.
Schwarzkopf R, Thompson SL, Adwar SJ, Liublinska V, Slover JD. Postoperative complication rates in the “Super-Obese” hip and knee arthroplasty population. J Arthroplasty. 2012; 27(3): 397-401.
Elkins JM, Daniel M, Pedersen DR, Singh B, Yack HJ, Callaghan JJ, Brown TD. Morbid obesity may increase dislocation in total hip patients: a biomechanical analysis hip. Clin Orthop Relat Res. 2013; 471(3): 971-80.
Bierry G, Le Minor JM, Schmittbuhl M. Oval in males and triangular in females? A quantitative evaluation of sexual dimorphism in the human obturator foramen. Am J Phys Anthropol. 2010; 141(4): 626-31.
Ridgeway BM, Arias BE, Barber MD. Variation of the obturator foramen and pubic arch of the female bony pelvis. Am J Obstet Gynecol. 2008; 198(5): 546.e1-4.
Asgian C, Gilbertson L, Hori R. Fatigue of tapered joints. En: Anderson JM (editor). Transections of 2nd World Congress on Biomaterials, 10th Annual Meeting of Society for Biomaterials. Washington DC: Hyatt Regency-Capitol Hill; 1984.
Woolson ST, Pottorff GT. Disassembly of a Modular femoral prosthesis after dislocation of the femoral component. J Bone Joint Surg Am. 1990; 72(4): 624-5.
Pellicci PM, Haas SB. Disassembly of a modular femoral component during closed reduction of the dislocated femoral component. J Bone Joint Surg Am. 1990; 72(4): 619-20.
Fillingham YA, Erickson BJ, Cvetanovich GL, Della Valle CJ. Dislocation of a total hip arthroplasty: Acute management in the ED. Am J Emerg Med. 2014; 32(12): 1554.e1-3.