Pseudoaneurysm following Two-Stage Hip Revision with Fasciotomy

Area of Science:

• Orthopedic Surgery
• Vascular Surgery
• Infectious Disease

Background:

• Total hip arthroplasty (THA) can be complicated by rare vascular issues like pseudoaneurysms.
• Pseudoaneurysms in THA patients often present with non-specific symptoms, mimicking infection or hematoma.
• A history of recurrent infections and dislocations increases the risk of pseudoaneurysm formation post-THA.

Observation:

• A 69-year-old male with a history of slipped capital femoral epiphysis and multiple prior hip surgeries presented with thigh pain.
• Initial diagnosis suggested periprosthetic joint infection; however, subsequent imaging revealed a large femoral pseudoaneurysm.
• The pseudoaneurysm was associated with a sharp bone fragment, likely a contributing factor to its formation.

Findings:

• Surgical exploration of the thigh hematoma revealed a pulsatile pseudoaneurysm without purulence.
• The pseudoaneurysm was successfully repaired by a vascular surgeon, and the bone fragment was removed.
• Despite pseudoaneurysm repair, the patient developed a subsequent periprosthetic joint infection requiring further treatment.

Implications:

• This case highlights the importance of considering pseudoaneurysm in the differential diagnosis of thigh hematomas after THA, especially when infection is suspected.
• Vascular surgeons and orthopedic surgeons must collaborate for optimal management of such complex cases.
• Awareness of this rare complication can improve diagnostic accuracy and patient outcomes in total joint arthroplasty settings.