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[Vascular risk and total hip arthroplasty].
L Beguin1, P Feugier, J M Durand
1Centre d'Orthopédie-Traumatologie, Pavillon 1-3, Hôpital Bellevue, CHRU de Saint-Etienne, 42055 Saint-Etienne Cedex 2.
Revue De Chirurgie Orthopedique Et Reparatrice De L'Appareil Moteur
|September 8, 2001
Summary
Vascular complications during total hip arthroplasty are rare but serious. Preoperative assessment and a retroperitoneal approach for acetabular revision can mitigate risks, especially in complex cases.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Surgical Complications
Background:
- Total hip arthroplasty (THA) carries a risk of vascular complications, with significant mortality (7%) and morbidity (19%).
- These iatrogenic injuries can transform planned procedures into emergencies.
Observation:
- A retrospective multicenter study identified 14 vascular complications during THA, with 6 occurring during revision surgery.
- Key risk factors for acetabular revision include intrapelvic dislocation, lack of bony barrier, and intrapelvic foreign bodies.
Findings:
- The retroperitoneal approach is recommended for acetabular revision in cases of intrapelvic dislocation or anomalous iliac vessels.
- This approach allows direct visual control of iliac vessels during implant removal.
Implications:
- Thorough preoperative evaluation, including arteriography, is crucial for identifying at-risk patients.
- A precise understanding of iliac vessel anatomy and trajectory relative to the acetabulum is essential for prevention.
- Vigilant surveillance before, during, and after surgery is vital for detecting and managing potential vascular injuries.