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A rescue method for a large femoral trial head trapped into the cup during direct anterior total hip arthroplasty without using a fracture table

Wei-Jen Chen, Chang-Han Chuang, Chun Hsien Huang, Ming-Chou Ku

Minimal invasive direct anterior approach (DAA) is an established procedure for total hip arthroplasty (THA). THA via DAA with a larger head size has been reported to reduce the risk of postoperative dislocation. Additionally, variations of the technique exist among different surgeons. Many surgeons prefer a standard surgical table to a fracture table because a standard surgical table less interfere the use of fluoroscopy and facilitates measuring leg length. Here, we presented a rare complication during THA via DAA with a 36 mm large head using a standard surgical table. A 59-y-old woman was diagnosed of bilateral dysplastic hip. The first (right) THA via DAA was done smoothly but a significant postoperative leg length discrepancy (LLD) was noted. To precisely evaluate the LLD in the second (left) THA via DAA, we used a standard surgical table. Intraoperatively, during the last trial reduction, the 36 mm trial head was trapped into the cup and could not be re-dislocated. In the meantime, the surgical table is not helpful for anterior traction to dislocate the head. Then, we decided to chisel the trial head and perform a controlled cracking on the calcar using an osteotome for further sub-siding the stem. Finally, the THA was completed smoothly and the patient did not complain a subjective LLD anymore. We suggest that surgeons should be aware of the slightly different length between the trial stem and the real stem, and should be careful about the selection of head size and type of surgical table in THA via DAA.