What question did this study set out to answer?

This research aims to evaluate the effectiveness of an algorithmic approach for retrieving medially migrated hip arthroplasty components.

May 16, 2026

Retrieval of Medially Migrated Hip Arthroplasty Components Using an Algorithmic Approach: Outcomes From a Two-Centre Study at Two to 18 Years’ Follow-Up

Key Points

This research aims to evaluate the effectiveness of an algorithmic approach for retrieving medially migrated hip arthroplasty components.
Retrospective review of 44 patients with medial prosthetic migration from two tertiary hospitals between 2014 and 2023.
Patients underwent various interventions including component retrieval and CT angiography evaluation of blood vessel proximity.
Outcomes assessed included postoperative recovery, complications, and changes in hip function using HOOS-JR scores.
86.4% of patients experienced medial component migration due to aseptic loosening, with notable improvements in HOOS-JR scores from 20.3 to 7.8 postoperatively (P<0.001).
61.4% of patients underwent stem revision, with few significant complications reported such as delayed wound healing and traumatic dislocation.
No neurovascular injuries were observed, supporting the safety of the algorithmic retrieval approach.

Abstract

Purpose This study presents the outcomes of an algorithmic approach to retrieve medially migrated total hip arthroplasty (THA) or bipolar hip hemiarthroplasty (BHH) prostheses. Methods We retrospectively reviewed 44 patients (19 women and 25 men, mean age: 53.5 +/- 13.2 years) with medial prosthetic migration following hip arthroplasty (38 THA, 6 BHH) from two tertiary care hospitals who underwent component retrieval between 2014 and 2023. Results Medial component migration caused by aseptic loosening (86.4%), infection (11.4%), or trauma (2.3%) resulted in Paprosky 3B (68.2%) or 2C (31.8%) defects in the cohort. Fifteen (34.1%) patients had protrusio with medial prosthetic bone coverage. Upon preoperative CT angiographic evaluation of the remaining patients, the shortest distance between the prostheses and major blood vessels was > 15mm sagittally and coronally in 21 (47.7%). The posterior approach alone was employed in these patient subgroups. Eight (18.2%) patients with acetabular cups within 15mm of the external iliac artery sagittally and/or coronally underwent preoperative Fogarty balloon placement and intrapelvic cup extraction through an additional approach (iliofemoral lateral window, ilioinguinal, or modified Stoppa, where the cup was lateral to, superimposed upon, or medial to the artery, respectively). Twenty-seven (61.4%) patients underwent stem revision; 11 (25%) required extended trochanteric osteotomy for cement retrieval, or extraction of well-fixed stems or non-dislocatable BHH prostheses. Three (6.8%) patients underwent Girdlestone arthroplasty; 41 (93.2%) underwent revision THA. The mean postoperative follow-up was 6.0 +/- 2.6 years. HOOS-JR improved significantly from 20.3 +/- 1.3 preoperatively to 7.8 +/- 2.9 postoperatively (P<0.001). No iatrogenic neurovascular or pelvic organ injuries occurred. Delayed wound healing, traumatic dislocation, instability requiring revision, and aseptic loosening following revision THA occurred in 2, 1, 1, and 2 patients, respectively. Conclusion The presented algorithm yielded acceptable outcomes following complex surgeries for a rare, potentially life-threatening complication of hip arthroplasty.

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Cite This Study

Malhotra et al. (Thu,) studied this question.

synapsesocial.com/papers/6a080985a487c87a6a40b6d2 https://doi.org/https://doi.org/10.1302/1358-992x.2026.4.078

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