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The Prevention and Treatment of Femoral Trial Head Loss in Total Hip Arthroplasty

March 28, 2018 | Surgery
Douglas Navasartian, MD, MS ; Paul Allegra, MD ; Benjamin Giliberti, MD ; David Chalnick, MD
Author and Disclosure Information

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article. 

Dr. Navasartian and Dr. Giliberti are Orthopaedic Surgery Residents, and Dr. Chalnick is an Attending Orthopaedic Surgeon, Monmouth Medical Center, Long Branch, New Jersey. Dr. Allegra is an Orthopaedic Surgery Resident, University of Miami, Miami, Florida.

Address correspondence to: Douglas Navasartian, MD, MS, Monmouth Medical Center, Department of Orthopaedic Surgery, 300 Second Ave., Long Branch, NJ 07740 (tel, 732-222-5200; email, douglas.navasartian@rwjbh.org).

Douglas Navasartian, MD, MS Paul Allegra, MD Benjamin Giliberti, MD and David Chalnick, MD . The Prevention and Treatment of Femoral Trial Head Loss in Total Hip Arthroplasty. Am J Orthop. March 28, 2018

TAKE-HOME POINTS

  • Femoral head trial loss is a complication that can occur during THA.
  • This event can be a source of avoidable morbidity.
  • Preventative measures can be taken to avoid this complication.
  • If preventative measures fail, retrieval of the femoral trial head can be performed.
  • A thorough understanding of preventative and retrieval methods is essential for surgeons that perform THA.

CONCLUSION

The femoral trial head often can be quickly and easily recovered; however, trial component recovery can sometimes be more complicated. Loss of the trial femoral head could potentially occur during dislocation, reduction, or any of the trial positions. An example of a more complicated recovery is when the femoral trial head is lost into the retroperitoneal space, which could occur when trialing the hip in extension to assess the anterior stability of the hip. Loss of the femoral trial head is an avoidable occurrence, and it has the potential to cause a number of complications as well as the need for additional incisions/surgery to retrieve the femoral trial head. The subsequent issues that could arise after loss occurs can not only lead to extensive surgical complications, but can also foster patient dissatisfaction regarding surgical outcomes. Therefore, consistent attempts to utilize preventative techniques are essential. As discussed, simple measures such as placement of a suture through the apical hole of the trial component and adequate communication between those involved in reduction and trialing maneuvers, can serve to avert femoral trial head loss.

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