We describe a safe operative approach for removal of a prosthesis that
has migrated into the pelvis, and we recommend that a two-stage
reconstruction be done when revising the total hip-replacement
arthroplasty. The first stage consists of the removal of the femoral
component and cement through a lateral transtrochanteric approach, followed
by removal of the acetabular component through an abdominal-retroperitoneal
approach to permit exposure of the major intrapelvic structures and to
ascertain their relationship to the acetabular component and cement. After
the acetabular component has been removed, bone grafts are applied to the
pelvis. Postoperatively, the patient is placed in traction for a time and
then is allowed to walk with non-weight-bearing. The second stage of
reconstruction, consisting of hip replacement, is performed nine to twelve
months after the first stage. A satisfactory result was obtained in the
four patients for whom we followed this operative regimen. In one patient,
the first-stage procedure yielded a satisfactory result and the second
stage was not done.