Acute External Iliac Artery Occlusion After Posterior Total Hip Arthroplasty: A Case Report

Acute limb ischemia is a rare but potentially limb-threatening complication following total hip arthroplasty. Although vascular injuries have been described in the literature, proximal arterial occlusion at the level of the external iliac artery after a primary posterior total hip arthroplasty, to our knowledge, has not been previously reported. We present the case of a 74-year-old woman who developed acute limb ischemia approximately 3 h after undergoing an primary posterior total hip arthroplasty without any intraoperative complications. On postoperative examination, she was noted to have diminished distal perfusion of the operative extremity. Upon return to the operating room, angiography revealed an acute occlusion of the external iliac artery. The patient underwent emergent thromboembolectomy, which successfully restored arterial flow. No underlying vascular disease or hypercoagulable condition was identified on further evaluation, and a positional or compression-related mechanism was hypothesized as the most likely mechanism. This case highlights an underrecognized but serious complication that may occur even in routine total hip arthroplasty. It underscores the importance of meticulous intraoperative positioning, heightened awareness of potential vascular compromise, and routine postoperative neurovascular assessment. Early recognition of ischemic signs and prompt surgical intervention are critical to preventing irreversible limb damage and optimizing patient outcomes.