Mechanisms of arterial injuries associated with total hip replacement

Five cases of arterial complications of total hip replacement, all of which can be explained on the basis of intraoperative injury, are reported, with diagrammatic analysis of the intraoperative mechanisms of injury involved. The injuries were manifested as hemorrhage, ischemia, or development of a pulsatile mass. Vascular structures affected include the external iliac, common femoral, medial femoral circumflex, and lateral femoral circumflex arteries. Arterial damage may result from retractor injury, thermal injury from methylmethacrylate, or direct penetration from polymer or gouging during acetabular preparation. An understanding of the mechanisms and location of arterial injury following hip replacement will aid the vascular surgeon in diagnosis, exposure, and repair of these injuries.