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Prevention of vascular injuries in revision total hip replacement
M al-Salman1, D C Taylor, C P Beauchamp
1Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver.
Insights
Severe hip replacement complications involving iliac vessel injury can be managed. Early surgical repair of iliac vessels before prosthesis removal is crucial for successful outcomes.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Radiology
Background:
- Total hip arthroplasty (THA) can lead to severe complications, including injury to iliac vessels.
- Such injuries are associated with significant hemorrhagic risks and increased mortality.
Observation:
- Seven patients with medial acetabular prosthesis displacement and iliac vessel injury post-THA were identified.
- Preoperative imaging revealed prosthesis in the pelvis, pelvic cement, and proximity to iliac vessels.
- Arteriography confirmed iliac vessel displacement or compression in all cases.
Findings:
- Surgical management involved medial exposure and iliac vessel repair prior to hip revision.
- No deaths, amputations, or hemorrhagic complications occurred postoperatively.
- Postoperative complications included deep vein thrombosis and graft occlusion, managed with further intervention.
Implications:
- Preoperative identification of iliac vessel involvement is critical for at-risk THA patients.
- A medial extraperitoneal approach for vessel repair before prosthesis removal is recommended.
- This approach can prevent severe hemorrhagic complications and improve patient outcomes in THA revisions.
Abstract:
Iliac-vessel injury from total hip arthroplasty is associated with hemorrhagic complications and an increased death rate. The authors identified seven patients who had severe medial displacement of the acetabular prosthesis and associated vascular injury to the iliac vessels after total hip replacement. One patient had two hip replacements. Preoperative findings included a pelvic mass (three hips), pelvic pain (eight), radiologic evidence of cement in the pelvis (three) and the acetabular prosthesis in the pelvis (eight), computed tomographic evidence of cement in the pelvis and proximity of the prosthesis to the iliac vessels (four), and arteriography showing displacement or compression of the iliac vessels (seven). Operative management in all cases involved medial exposure, mobilization and repair of the iliac vessels before revision of the hip prosthesis. Postoperative complications were deep vein thrombosis (three), in spite of prophylaxis, and occlusion of a vein interposition graft (one) requiring placement of a femoral crossover graft. There were no deaths, amputations or hemorrhagic complications. The authors advocate preoperative identification of patients who have iliac-vessel involvement by their total hip prosthesis and initial medial extraperitoneal exposure and repair of these vessels before removal of the displaced acetabular prosthesis.