PMC4900056_01
Frontal radiographs of the pelvis after (A) initial total hip arthroplasty in 1998, (B) revision bipolar arthroplasty and acetabular graft in 2008, and (C) acetabular reconstruction and placement of antiprotrusio cage in 2009 showing progressive medial migration of the left acetabular and femoral hardware and left pubic rami insufficiency fractures.
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An antiprotrusio cage was placed (Fig. 1).
CT examination of the abdomen and pelvis on admission. (A) CT scout image demonstrates multiple dilated loops of small bowel from ileus and severe protrusio of the acetabular and femoral hardware. (B) Coronal and (C) axial CT images of the pelvis show complete discontinuity of the medial acetabular wall, and a hook-shaped flange of the acetabular cage traversing the sigmoid colon wall (arrow).
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A portion of the hardware was seen to penetrate the wall of the sigmoid colon, and a large amount of fluid and gas was seen surrounding the left hip and greater trochanter (Fig. 2).
Intraoperative photograph demonstrates the proximity of the penetrating flange of the acetabular cup (arrowhead) to the left external iliac artery (arrow). Note the stapled proximal sigmoid colon (asterisk).
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Surgery revealed a 1-cm titanium flange of the acetabular cage perforating the sigmoid colon (Fig. 3) and proximal small bowel dilatation likely due to ileus.