Trial femoral head loss in to the soft tissues of pelvis during primary total hip replacement: a case report
© Vertelis et al; licensee BioMed Central Ltd. 2008
Received: 17 August 2008
Accepted: 12 September 2008
Published: 12 September 2008
The loss of trial femoral head in the soft tissues is a rare per operative complication in total hips replacement. We report the loss of the femoral head in surrounding hip joint soft tissues and unsuccessful attempts to locate and remove it. Surgeons should be aware of such complication as trial femoral heads usually are made from non radiolucent material and cannot be detected by regular x-ray examination during surgery. The industry should consider manufacturing trial femoral heads from x-ray visible material.
At 3 months follow up patients prosthetic hip was asymptomatic. Eight months after the surgery additional CT scan was performed. The head was found in the same place as in previous CT and no reaction of surrounding tissues was observed.
We found very few reports in the literature describing similar cares. O. Batouk and M. Gilbart  described the intraoperative loss of trial femoral head and unsuccessful attempts to remove it. A. Princep et al.  described the options how to remove the migrated femoral head. He suggested that pressing the supra-ingvinal area, also flexing the hip would be helpful. A tea-spoon, as a tool was suggested for removal of the trial femoral head by the author. D. Alfonso et al.  suggested fixing the trial head with a strong suture to prevent its loss.
We observed no complications related to the femoral head loss in pelvis in our case. However the prevention of such events is of importance. Despite the all precautions these events might happen and orthopedics surgeon should have tools resolve this problem. The trial femoral head is not notable on x-rays and the CT scan during the prosthetic surgery is complicated. The industry should consider manufacturing trial femoral heads from the material which could be visible during conventional x-ray examination.
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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