Acute Arterial Ischemia Secondary to Intrapelvic Acetabular Migration: A Multidisciplinary Approach

This case report evaluates current diagnostic and treatment approaches for intrapelvic acetabular migration, focusing on the rare but serious complication of acute limb ischemia following hip arthroplasty. A 67-year-old female with a history of total hip arthroplasty 10 years ago presented with acute limb ischemia after experiencing a traumatic event 72 hours prior, which had caused displacement of her hip prosthesis. Notably, she had a history of a traumatic event two years earlier for which she had been advised to undergo surgical correction, which she had refused. A multidisciplinary team assessed her preoperatively. She was diagnosed with SVS III irreversible acute limb ischemia due to compression of the external iliac artery from the prosthesis migration, prompting an emergency hip disarticulation. The patient successfully underwent hip disarticulation and mechanical thrombectomy of the external iliac artery using a Fogarty catheter. Postoperative recovery was notable, with significant pain relief, improved mental status, and restoration of the iliac pulse. Early diagnosis and management of acute arterial injury are crucial to preventing severe outcomes. This report highlights the importance of timely intervention to mitigate limb-threatening and life-threatening complications. It underscores the need for vigilant monitoring during hip replacements and the effectiveness of a multidisciplinary approach in complex cases. Continued research is essential to enhance diagnostic and therapeutic strategies for this rare yet critical complication and to improve overall patient outcomes.