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Total hip arthroplasty with acetabular fixation: an unexpected complication
Orthopedics
|April 26, 2014
Summary
Total hip arthroplasty (THA) can rarely cause vascular injury. This case highlights a unique presentation of deep venous thrombosis due to acetabular screw compression of the common femoral vein after THA.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Trauma Surgery
Background:
- Vascular injuries during total hip arthroplasty (THA) are uncommon but can lead to severe complications.
- Key pelvic vascular structures at risk include the external iliac, femoral, and obturator vessels.
- Acetabular reaming and screw hole drilling are potential mechanisms for vascular injury.
Observation:
- A 72-year-old female patient sustained acetabular and femoral head fractures, treated with THA and pelvic fixation.
- Postoperatively, she developed deep venous thrombosis (DVT) in her calf and subsequently, an occluding thrombus in the common femoral vein.
- Surgical exploration identified an acetabular screw compressing the common femoral vein, causing the vascular occlusion.
Findings:
- The patient presented with an unusual cause of common femoral vein occlusion following THA and pelvic fixation.
- The vascular compression was directly attributed to an improperly placed acetabular screw.
- The presentation highlights a rare but critical complication potentially masked by the more common incidence of DVT.
Implications:
- Early recognition of vascular compression is crucial for prompt management and preventing severe morbidity.
- Thorough preoperative planning and intraoperative imaging (e.g., C-arm) are essential to minimize vascular risks.
- This case underscores the importance of considering mechanical vascular compression as a cause of DVT after hip and pelvic surgery.
