Cement fragment induced external iliac artery pseudoaneurysm: a rare complication following total hip arthroplasty

Vascular injury is a rare but important complication following a total hip arthroplasty (THA). The occurrence of such an event can be difficult to detect and manage due to the time frame in which this can occur. We report a case of a female patient in her 70s who presented 19 months post right THA with right-sided acute limb ischaemia. Initial imaging revealed occlusion at the level of the right common and external iliac arteries. The patient was treated with a successful embolectomy, but muscle death in the leg, leading to acidosis resulted in the right leg being amputated. Postoperatively, a drop in the haemoglobin levels without any visible bleeding and the presence of a new suprainguinal pulsatile swelling warranted a CT angiogram. This demonstrated a false aneurysm originating from the distal right external iliac artery, precisely at the point where it encountered a cement spicule from the previous THA.