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[Arterial vascular lesions after total hip joint replacement]
A Schätzler1, P Heilberger, M Möllers
1Klinik für Unfallchirurgle, Klinikum Nürnberg Süd.
Insights
Total hip replacement can lead to external iliac artery thrombosis due to component issues. Angiography is recommended for acute limb ischemia, with extra-anatomic bypasses preferred over thrombectomies for treatment.
Area of Science:
- Vascular Surgery
- Orthopedic Surgery
- Medical Device Complications
Background:
- Total hip replacement (THR) is a common orthopedic procedure.
- Complications involving major blood vessels are rare but serious.
- External iliac artery (EIA) thrombosis is a potential, though infrequent, complication.
Observation:
- Three cases of EIA thrombosis following THR are presented.
- Thrombosis was linked to acetabular component protrusion or cement/spongiosa impaction.
- One case of intraoperative arterial injury during revision THR is also described.
Findings:
- Compression of iliac vessels by prosthetic components or bone cement can cause thrombosis.
- Acute ischemic syndromes in lower limbs post-THR warrant investigation for extravascular compression.
- Angiography is crucial for diagnosing these vascular complications.
Implications:
- Early diagnosis via angiography can identify extravascular causes of thrombosis.
- Extra-anatomic bypass grafting is recommended as the preferred surgical treatment.
- Thrombectomy may be less effective than bypass for managing post-THR EIA thrombosis.
Abstract:
We report on three arterial thromboses of the external iliac artery following total hip replacement. As a result of implanted cement/spongiosa or protrusion of the acetabular component, the iliac vessels were compressed. Furthermore, we report about one intraoperative arterial vessel lesion in a 65-year-old patient during a revision operation. We recommend that in case of acute ischemic syndromes of lower limbs following total hip replacement, an angiography should be performed in order to exclude an extravascular cause of thrombosis. For therapy in those cases extra-anatomic bypasses should be preferred to thrombectomies.