Proctitis Associated with a Prominent Acetabular Screw into the Pelvis 21 Years after Total Hip Arthroplasty

Abstract

An 81-year-old woman presented with a severe right lower abdominal pain with sudden onset after exercise. She had a previous history of undergoing a total hip arthroplasty 21years before admission. Computed tomography (CT) showed that prominent acetabular screw tips into the pelvis had impinged against the rectum. A follow-up CT on the next day showed worsening of edematous changes of the sigmoid colon and the rectum, therefore an emergency operation was indicated. Intra-operative findings revealed that the inflammatory changes were associated with the impingement of a 2-cm screw prominence. Removing or shortening of the screw was avoided because the tip had pierced the right external iliac vein. We applied a type of hernia mesh, ULTRAPROTM Hernia System (UHS), to cover the tip and to intervene between the tip and the rectum. The patient's postoperative course was uneventful. We conclude that an application of UHS is useful when removing or shortening of prominent acetabular screws cannot be executed.