Beyond the wall: complex excision arthroplasty through a paramedian abdominal approach for intrapelvic cup migration

• Published in: BMJ case reports 2019-12, Vol.12 (12), p.e233266
• Main Authors: Fenelon, Christopher, Curtin, William, Tubussam, Muhammad, Murphy, Colin G
• Format: Article
• Language: English
• Subjects: Abdomen; Abdomen - surgery; Acetabulum - surgery; Aged; Arthroplasty, Replacement, Hip; bone and joint infections; Case reports; Foreign-Body Migration - diagnostic imaging; Foreign-Body Migration - surgery; Hip Prosthesis; Humans; Images In; Joint surgery; Male; orthopaedic and trauma surgery; Postoperative Complications - surgery; Prostheses; Prosthesis Failure; Radiography; Teams; Urology; Vascular surgery
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2019-233266

Correspondence to Dr Christopher Fenelon; [e-mail] Description Excision arthroplasty or a ‘Girdlestone’ procedure was originally developed for treating hip tuberculosis, but is now more commonly performed to salvage an infected total hip replacement (THR).1 The operation is typically performed through a standard lateral or posterior approach. A discharging sinus over the lateral aspect of his hip persisted since his last surgery performed 10 years prior to presentation He was referred to our orthopaedic service from another hospital with large blood clots draining from his sinus and a haemoglobin fall from 109 to 89 g/L. Thorough preoperative preparation is required to ensure the necessary investigations are performed, essential specialities involved (including a blood transfusion laboratory) and sufficient access to intensive or high dependency unit care available, and careful coordination of the sequence, timing, and approaches of the respective surgical teams is done.