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Mitigation of Vascular Complications in Revision Total Hip Arthroplasty with Intra-Pelvic Migration of Implants: A
Vijay Kumar1, Apoorva Kabra2, Abhijit Behera1
1Department of Orthopaedics, AIIMS, New Delhi, India.
Background:
Intra-pelvic migration of implants or cement following total hip arthroplasty (THA) is a rare, but serious complication that can lead to life-threatening vascular injuries during revision surgery. The close proximity of migrated components to major pelvic vessels markedly increases the risk of intraoperative hemorrhage, necessitating a strategic preoperative and intraoperative approach.
Methods:
This retrospective study evaluated 17 patients undergoing revision THA for intra-pelvic implant or cement migration at a tertiary care center between 2020 and 2025. All patients underwent preoperative computed tomography angiography (CTA) to assess vascular proximity. Patients who had implants or cement within five mm of pelvic vessels underwent preoperative endovascular intervention-either balloon catheter placement (n = 8) for larger vessels or arterial coiling/glue (n = 5) for smaller branches. Intra- and postoperative outcomes, including vascular injuries, blood losses, transfusion needs, and complications, were assessed.
Results:
Vascular proximity was identified in 13 of 17 patients. Following our proposed algorithm, endovascular interventions were successfully performed in all 13 patients, without perioperative complications. There was one patient who required balloon inflation intraoperatively to control bleeding, with no subsequent hemodynamic instability or mortality. There were no major vascular injuries or emergency conversions that occurred. The mean blood loss was 1,310 ± 121 mL in the intervention group versus 1,400 ± 248 mL in the non-intervention group. There were three patients who each underwent two-stage procedures and Girdlestone arthroplasties, four who underwent single-stage revision, and three who are awaiting the second-stage procedure.
Conclusion:
A preoperative algorithm incorporating CTA and selective endovascular intervention effectively mitigates vascular risks in revision THA with intra-pelvic migration. Balloon catheter placement and arterial coiling offer targeted vascular protection, enabling safer surgical execution. This multidisciplinary, algorithmic strategy enhances patient safety and surgical outcomes in complex revision hip arthroplasty.
