Common Femoral Artery Thrombosis Post Hip Hemiarthroplasty: A Case Report

Femur neck fractures are among the most common presentations seen in trauma centers. Surgical fixation of the fracture versus hip joint arthroplasty is the standard modality of treatment. The appropriate treatment modality is decided based on the patient's fracture pattern, activity level prior to the injury, fitness for surgery, and availability of resources. Total or hemi hip arthroplasties are effective and well-optimized procedures. However, they do not come without the risk of complications, some of which can cause significant morbidity to the patient. We present a case of a vascular complication in a femur neck fracture, treated through a hemi hip arthroplasty. Our patient is a 67-year-old woman with a known history of hypertension and a long-standing history of heavy smoking. Admitted as a case of a basicervical femur neck fracture sustained secondary to a fall from a standing height, she underwent an uneventful hip hemiarthroplasty. However, her distal limb pulses were not palpable in the recovery area postoperatively and were not detectable on a Doppler ultrasound. CT angiography revealed an arterial thrombus and intimal tear in the common femoral artery. An arterial thrombectomy and an intimal repair were performed, and good limb perfusion was restored. Arterial injuries during joint replacement surgery are rare but serious complications. Prompt investigations in the form of a Doppler ultrasound of the distal pulses and CT angiography with urgent vascular surgery consultation, if needed, are crucial. If detected and treated early, limb perfusion can be restored. However, late detection could lead to drastic outcomes, which can include loss of limb and loss of function. The risk of perioperative vascular complications can be minimized intraoperatively through proper handling of surgical instruments and careful dissection and traction of limbs. Pre- and postoperative physical examinations, as well as having a high index of suspicion for such injuries, are important for early detection and better outcomes.