Intrapelvic migration of a trial femoral head during direct anterior approach total hip arthroplasty: a case report and literature review.

INTRODUCTION: The direct anterior approach (DAA) for total hip arthroplasty (THA) is increasingly adopted due to faster postoperative recovery. However, rare intraoperative complications such as intrapelvic migration of a trial femoral head remain poorly characterized, and optimal management strategies are not well established. This study aimed to describe a novel intraoperative retrieval technique and evaluate its feasibility and safety. METHODS: We report a single case of intrapelvic trial femoral head migration occurring during primary THA performed via the DAA at our institution. Intraoperative findings, decision-making, and surgical management were documented. A modified approach involving partial transection of the rectus femoris muscle was employed to facilitate manual retrieval of the migrated component. RESULTS: The migrated trial head was successfully retrieved manually after approximately 30 min. No laparotomy or additional surgical intervention was required, and no neurovascular or visceral injury was identified. The patient subsequently underwent postoperative rehabilitation, with the Harris Hip Score (HHS) was 77 points at discharge (week 4), and the latest HHS score was 83 point after 7-months follow-up (May 2026). DISCUSSION: This case demonstrates that a minimally invasive, direct retrieval strategy may be a feasible alternative to conventional approaches such as laparotomy or laparoscopy, which carry higher risks of morbidity. The technique expands current management options for this rare complication and may help improve intraoperative safety. Further studies are needed to validate its generalizability and establish standardized treatment algorithms.