Intraoperative bladder perforation during primary total hip arthroplasty

An uncommon case of a bladder injury due to hip prosthesis migration: A case report

Bladder injuries, although rare, can occur as a complication of hip surgery, particularly when a hip prosthesis migrates into the bladder. We present the case of a 75-year-old woman with a bladder rupture secondary to prosthesis migration requiring repair via a transvesical approach. While total hip arthroplasty (THA) is common, intrapelvic complications such as bladder injury are less commonly reported. Early recognition and appropriate treatment are essential to avoid serious consequences. The management of prosthesis migration into the bladder is complex and requires detailed anatomical knowledge. Awareness of this potential complication is essential for both orthopaedic surgeons and urologists.

Genitourinary complications in orthopaedic surgery

Genitourinary complications following orthopaedic intervention are uncommon but well-described occurrences and exist on a spectrum of severity. These complications vary depending on the anatomic location and surgical approach, with surgery of the spine, hip, and pelvis of particular concern. Injuries to the urinary tract may present acutely with urinary retention or hematuria. However, they often have a delayed presentation with severe complications such as urinary fistula and recurrent infection. Delayed presentations may place the onus of timely and proper diagnosis on the orthopaedic provider, who may serve as the patient's primary source of long-term follow-up. Detailed knowledge of anatomy and at-risk structures is key to both preventing and identifying injury. Although iatrogenic injury is not always avoidable, early identification can help to facilitate timely evaluation and management to prevent long-term complications such as bladder dysfunction, obstructive renal injury, sexual dysfunction, and chronic pain.  Keywords: urologic injury, bladder injury, genitourinary injury, hip arthroplasty, pelvic ring injuries, spine surgery.

Bladder perforation by orthopedic implants 26 years after limb-sparing surgery for left proximal femoral chondrosarcoma: A case report

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A patient underwent limb-sparing surgery for left proximal femoral chondrosarcoma.

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Bladder perforation by staples occurred 26 years after limb-sparing surgery.

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No reports describe staple migration into the bladder after limb-sparing surgery.

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Bladder injury is possible in patients with urinary symptoms after pelvic surgery.

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Implant complications may occur even after a long postoperative period.

Introduction

The need for implant use during orthopedic surgeries has been increasing. Accordingly, increased implant failures have been reported. However, bladder perforation remains a rare complication after orthopedic surgery. Although a few reports have described bladder perforation after total hip arthroplasty, no previous studies have reported the migration of staples into the bladder after limb-sparing surgery.

Presentation of case

A 65-year-old patient underwent limb-sparing surgery to remove a chondrosarcoma in the left proximal thigh. Twenty-six years after surgery, a staple that had been used to fix artificial ligaments to the pubis migrated to perforate the bladder, resulting in painful urination. The staple was removed, and her symptoms improved.

Discussion

In this case, bladder perforation by the staple resulted in painful urination. The bladder perforation was not detected until 26 years after the initial surgery.

Conclusion

Our observations emphasize that implant complications may occur even after a long postoperative period, and the possibility of delayed bladder perforation from previous pelvic surgeries should be considered in patients presenting with urinary tract symptoms.