Vascular complication following total hip replacement - A nightmare for Arthroplasty surgeon

Abstract

Over the years, progressive advancements in the field of arthroplasty have made the total hip arthroplasty procedure relatively safe and well accepted for non salvageable hips. Nevertheless iatrogenic vascular injuries during total hip arthroplasty are rare but have serious consequences on the limb survival and function.1–4 The early diagnosis of vascular injuries is often difficult as the signs and symptoms are not specific and moreover these subtle signs are masked by effect of epidural or spinal anaesthesia in immediate post-operative period. The average frequency is between 0.16% and 0.25%. Various mechanisms described in literature for causing iatrogenic vascular insult are injuries by retractors, mechanical stress, laceration, thrombotic occlusion and formation of false aneurysm.1,2,5–7 Such complications better be prevented or efficiently treated by thorough pre-operative evaluation and vigilant post-operative examination. Salama R et al.8 is credited for reporting the first case of an arterial injury during THA. The most commonly affected vessels are the external iliac artery and the common femoral artery. A case of common femoral artery thrombosis following THA is presented with emphasis on difficult aspect of diagnosis and management. An attempt is also made to review the literature on possible mechanisms, risk factors, diagnosis and management of iatrogenic vascular injuries during THA.