Caecal perforation secondary to intrapelvic migration of a total hip prosthesis: A case report and a review of the literature

Introduction: Total hip arthroplasty (THA) is commonly performed to alleviate hip pain and restore function. While generally safe, complications such as prosthesis migration can occur. Intrapelvic migration of hip prostheses, leading to bowel perforation and fistula formation, is a rare but severe complication requiring prompt diagnosis and management. This case report, presented in line with the SCARE criteria, highlights a case of caecal perforation due to hip prosthesis migration. Case presentation: A 78-year-old female with a history of right THA presented with severe hip pain, loss of function, and a persistent fistula exuding fecaloid fluid. Examination revealed fever, rigidity, and limited hip motion. CT scans showed intrapelvic protrusion of the prosthetic components and a colo-cutaneous fistula. Emergency laparotomy revealed caecal perforation by a screw from the acetabular component, necessitating resection of the perforated caecum. A subsequent surgery addressed the hip prosthesis. The patient recovered uneventfully and was discharged on day 7. Discussion: Prosthesis migration into the pelvis is a serious complication of THA. Risk factors include implant loosening, acetabular bone loss, surgical technique issues, and patient factors like obesity and osteoporosis. Diagnosis relies on imaging studies. Management typically involves surgical removal of the migrated prosthesis and repair of the perforation, necessitating a multidisciplinary approach. Conclusion: Caecal perforation due to intrapelvic migration of a hip prosthesis is rare but potentially life- threatening. Prompt diagnosis and appropriate management are crucial. Further research is needed to better understand risk factors and prevention strategies.