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Individualized Stem-positioning in Calcar-guided Short-stem Total Hip Arthroplasty
Published on: February 27, 2018
Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants
Cristiano V Diesel1, Marcelo R Guimarães1, Samuel M Menegotto1
1Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Insights
A novel algorithm effectively identifies and prevents vascular injury during revision hip arthroplasty. This approach aids in managing patients at risk of vascular complications from intrapelvic components.
Area of Science:
- Orthopedic Surgery
- Vascular Surgery
- Medical Imaging
Background:
- Intrapelvic components in revision hip arthroplasty pose a risk of vascular injury.
- Early identification and prevention strategies are crucial for patient safety.
Purpose of the Study:
- To describe an algorithm for identifying and preventing vascular injury in patients with intrapelvic components.
- To assess the efficacy of the algorithm in high-risk revision hip arthroplasty cases.
Main Methods:
- Patients were considered at risk if components or cement migrated >5 mm beyond the ilioischial line.
- A serial investigation involving CT angiography and vascular surgeon evaluation was initiated for at-risk patients.
- The primary goal was to ensure a safe tissue plane between implants and vessels.
Main Results:
- The algorithm identified six out of ten at-risk patients as high risk for vascular injury during surgery.
- Preventive preoperative stents were implanted in these six high-risk patients.
- Four patients required a second reinforcing stent to maintain vessel anatomy.
Conclusions:
- The developed evaluation algorithm proved effective in preventing blood vessel injury during revision total hip arthroplasty.
- The algorithm is beneficial for managing high-risk patients undergoing complex hip revision procedures.
Aims:
Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components.
Methods:
Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels.
Results:
In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants.
Conclusion:
The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients.Cite this article: Bone Jt Open 2022;3(11):859-866.
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