Intraoperative bladder perforation during primary total hip arthroplasty.

Area of Science:

• Urology
• Orthopedic Surgery

Background:

• Total hip arthroplasty (THA) is a common orthopedic procedure.
• Bladder injury is a rare but serious intraoperative complication during THA.
• Aberrant bladder anatomy can increase the risk of iatrogenic injury.

Observation:

• A unique case of bladder perforation during primary THA is presented.
• The patient had idiopathic erosion of the quadrilateral space, suggesting abnormal bladder anatomy.
• Preoperative risk factors for bladder injury include cemented acetabular components, prior hip surgery, pelvic trauma, and poor bone quality.

Findings:

• The patient's aberrant bladder anatomy likely predisposed them to intraoperative bladder perforation.
• Standard management for bladder injury involves Foley catheterization, antibiotics, hemodynamic monitoring, and urology consultation.

Implications:

• Highlights the importance of preoperative urologic evaluation for identifying patients with potential bladder anomalies before THA.
• Intraoperative bladder decompression via Foley catheter may mitigate the risk of perforation in susceptible patients.
• This case underscores the need for vigilance regarding potential bladder injury during hip arthroplasty procedures.