Cirugía de revisión en artroplastía total de cadera con migración de componente acetabular al espacio subperitoneal. Reporte de caso y revisión de literatura.

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Title:	Cirugía de revisión en artroplastía total de cadera con migración de componente acetabular al espacio subperitoneal. Reporte de caso y revisión de literatura.
Alternate Title:	Total hip arthroplasty revision surgery with migration of acetabular component to the subperitoneal space. Case report and literature review.
Authors:	Cornejo-Albán, P. V.¹, Ramos-Flores, X. A.², Peñaherrera-Carrillo, C. P.³, Endara-Urresta, F.³, Vaca-Pérez, P. S.³ santiago_104@hotmail.es
Source:	Acta Ortopédica Mexicana. mar/apr2025, Vol. 39 Issue 2, p109-116. 9p.
Subjects:	TOTAL hip replacement, FEMUR, POROUS metals, FEMUR head, HIP surgery, REOPERATION
Abstract (English):	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. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Introducción: la cirugía de revisión en artroplastía total de cadera asociado a desgaste y aflojamiento de sus componentes se ha transformado en un procedimiento de rutina. La artroplastía de revisión se encuentra ampliamente expuesta en la literatura. Sin embargo, los casos que se presentan con aflojamiento y migración intrapélvica del componente acetabular son menos frecuentes. Caso clínico: femenino de 82 años, sin antecedentes clínicos de importancia, salvo por una artroplastía total de cadera derecha cementada hace un mes. La paciente no tolera la bipedestación ni la sedestación, y no deambula. Miembro inferior derecho: cadera: presencia de herida cicatrizada de aproximadamente 12 cm. Rangos de movilidad no valorables por dolor, limitados. Harris Hip Score (HHS) 16 puntos y la escala visual análoga (EVA) de 8/10, se evidencia en estudios de imagen migración medial intrapélvica de componente acetabular sin lesión de grandes vasos. Se realiza cirugía de revisión con retiro de componente acetabular y femoral. Se descarta infección mediante alfa-defensina. Posteriormente, se coloca aloinjerto óseo en defecto acetabular, luego malla metálica sobre aloinjerto y colocación de cuña de tántalo para cofinalmente colocar copa acetabular. Por último, se coloca vástago femoral de anclaje diafisaria, cabeza femoral de 28 mm sistema doble movilidad y reducción de componentes protésicos con adecuada estabilidad y recuperación de biomecánica de la cadera. Conclusiones: las distintas opciones expuestas para tratamiento y la combinación de técnicas presentan ventajas y desventajas. Las copas y aumentos de metal altamente poroso mostraron resultados satisfactorios para corregir defectos severos como es el caso expuesto, con una mejoría en HHS de 64 puntos y EVA de 8 puntos al año postquirúrgico. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
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. [ABSTRACT FROM AUTHOR]
ISSN:	23064102
DOI:	10.35366/119393