Stoppa approach for intrapelvic damage control and reconstruction of complex acetabular defects with intra-pelvic socket migration: A case report

Highlights • A novel surgical technique for reconstructing pelvic defects in hip revision surgery is described. • The Stoppa approach allows for pelvic damage control and reconstruction of bone defect. • The bone reconstruction is made by combining an intrapelvic plating with augmented socket reconstruction.
Introduction Failed hip arthroplasty with intrapelvic acetabular migration can be challenging due to the potential damage of intrapelvic structures. Presentation of the case We present a case of a 75 year-old lady with failed hip arthroplasty with loosening of implants and intra-pelvic migration of the cup, antiprotrusio cage mesh, screws and plate. A modified Stoppa approach was performed, a part of the migrated elements were safely removed, the intrapelvic structures were controlled, and the bone defect was reconstructed through the Stoppa approach combined with the lateral window of ilioinguinal approach by means of bone struts and metallic plates, which is a novel technique. Then an extended posterolateral hip approach was done and the acetabulum was reconstructed using porous tantalum augments and morselized allograft. A cemented constrained socket was implanted. After one-year follow-up the patient is able to walk with one crutch without pain. Discussion Due to intrapelvic migration, the implants used in hip arthroplasty may become entrapped between the anatomical structures lodged in the pelvis and cause damage to them. A careful preoperative assessment and planning are mandatory. A migrated socket can be inaccessible through a conventional hip approach and removal could be very difficult and dangerous. Conclusion The Stoppa approach in hip revision surgery can be a complement to traditional approaches to control the intrapelvic structures, remove migrated implants of previous surgery and reconstruct the pelvic defect.