Removal of an intra-pelvic socket: description of a safe surgical algorithm

Migration of an acetabular component beyond the ilio-ischial line is a rare but potentially lethal complication following a total hip arthroplasty, because the socket can become entrapped between the iliac vessels. Pre-operative assessment of the position of the socket relative to the intra-pelvic vascular structures is always mandatory to set up a staged procedure with a retroperitoneal exposure of the iliac vessels. This allows for a safe mobilization and looping of the vessels followed by extraction of the component either through the retroperitoneal or standard surgical approach to the hip joint. This strategy will minimize the risk of disruption of the vessels and of uncontrollable bleeding in case of vessel damage.