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Chapter 48 Video 1: Stoppa Approach for Removal of the Intrapelvic Cup for Acetabular Revision

November 07, 2016

Contributors: Francisco Chana, MD, PhD; Manuel Villanueva, MD, PhD; Jose Manuel Rojo-Manaute, MD, PhD; Jose Ramón Fernández-Mariño, MD, PhD; Javier Vaquero-Martin, MD, PhD

Failure of total hip arthroplasty with perforation of the medial acetabular wall and central migration of the prosthetic components is a rare, but severe, complication. The proximity of the prosthesis to major arteries may lead to life-threatening hemorrhage and has been associated with pain and visceral complications. If a standard approach for primary arthroplasties is used to remove the component through the defect in the inner wall of the pelvis, uncontrollable bleeding or damage to the pelvic organs can occur. For that reason, several techniques for removing acetabular cups have been reported, including the unilateral approach from the femoral side, the bilateral approach, the retroperitoneal approach, and the transabdominal approach. This video describes the preoperative planning and the surgical procedure for removing severely displaced acetabular components. It also outlines the authors' recommendation of the Stoppa approach, which has the advantages of simple dissection, a low complication rate, and the prevention of possibly life threatening problems.