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Diesel CV, Guimarães MR, Menegotto SM, Pereira AH, Pereira AA, Bertolucci LH, Freitas EC, Galia CR. Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants. Bone Jt Open 2022; 3:859-866. [DOI: 10.1302/2633-1462.311.bjo-2021-0188.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. Conclusion The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients. Cite this article: Bone Jt Open 2022;3(11):859–866.
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Affiliation(s)
- Cristiano V. Diesel
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Marcelo R. Guimarães
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Samuel M. Menegotto
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Adamastor H. Pereira
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Alexandre A. Pereira
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Leonardo H. Bertolucci
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduarda C. Freitas
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carlos R. Galia
- Grupo de Pesquisa em Cirurgia de Quadril, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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Smith CD, Sridhar MS. Life-Threatening, Bleeding Pseudoaneurysm of the External Iliac Artery in the Setting of an Infected Total Hip Arthroplasty from Pasteurella multocida. Arthroplast Today 2020; 6:560-565. [PMID: 32793788 PMCID: PMC7413924 DOI: 10.1016/j.artd.2020.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 02/03/2023] Open
Abstract
We present a bleeding, infected (mycotic) pseudoaneurysm from the organism Pasteurella multocida. The patient presented septic from an infected total hip arthroplasty and was treated with surgical debridement, component retention, and antibiotics. She re-presented with hip pain and a marked hemoglobin decrease. Vascular studies revealed a pseudoaneurysm of the external iliac artery and large hematoma secondary to contiguous spread of her hip infection. The pseudoaneurysm was treated with an endovascular stent before further debridement surgery to avoid exsanguinating hemorrhage with surgical release of her tamponade. This case demonstrates the utmost importance of recognizing and treating vascular pathology in a patient with an infected prosthetic hip, large hematoma, and decreased hemoglobin.
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Affiliation(s)
- Cory D Smith
- Department of Orthopedic Surgery, Prisma Health - Upstate, Greenville, SC, USA
| | - Michael S Sridhar
- Department of Orthopedic Surgery, Prisma Health - Upstate, Greenville, SC, USA
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Wilson JM, Escobar GA, Badrinathan B, Reimer NB. External iliac pseudoaneurysm secondary to medial wall penetration of an acetabular screw: a rare cause of total hip arthroplasty failure 15 years after implantation. Arthroplast Today 2019; 5:264-268. [PMID: 31516962 PMCID: PMC6728537 DOI: 10.1016/j.artd.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 12/17/2022] Open
Abstract
Vascular injury as a result of total hip arthroplasty (THA) represents an uncommon complication. Although these injuries typically present acutely, delayed presentation has been reported. In this case, a 70-year-old female presented with groin pain and medial thigh numbness 15 years after a left THA. After initially being misdiagnosed, repeat imaging revealed a large external iliac pseudoaneurysm as a result of a transacetabular screw penetrating the medial acetabular wall. The patient underwent staged endovascular exclusion of the pseudoaneurysm, percutaneous drainage, and revision THA. She had resolution of her symptoms. To our knowledge, this is the only reported case of a late vascular injury related to an aseptic THA with well-fixed components. Staged treatment with endovascular exclusion and revision THA is a viable approach.
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Affiliation(s)
- Jacob M Wilson
- Department of Orthopaedic Surgery, Emory Orthopaedic & Spine Center, Atlanta, GA, USA
| | - Guillermo A Escobar
- Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, GA, USA
| | - Barath Badrinathan
- Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, GA, USA
| | - Nickolas B Reimer
- Department of Orthopaedic Surgery, Emory Orthopaedic & Spine Center, Atlanta, GA, USA
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Slullitel PA, Llano L, García-Ávila C, Diaz-Dilernia F, Piccaluga F, Buttaro M, Zanotti G, Comba F. Unaddressed arterial injuries in revision total hip arthroplasty: mortality outcomes of a low-prevalence complication. INTERNATIONAL ORTHOPAEDICS 2019; 44:23-29. [DOI: 10.1007/s00264-019-04358-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/05/2019] [Indexed: 11/24/2022]
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Chen JL, Yang TY, Chuang PY, Huang TW, Huang KC. Pseudoaneurysm rupture with hemorrhagic shock in a patient with periprosthetic hip joint infection: A case report. Medicine (Baltimore) 2018; 97:e11028. [PMID: 29952941 PMCID: PMC6039624 DOI: 10.1097/md.0000000000011028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Although pseudoaneurysm (PA) formation following primary and revision total hip arthroplasty (THA) is rare, PA rupture may lead to severe complications that can result in a threat to life and limb. PATIENT CONCERNS A 65-year-old man presented with acute hemorrhagic discharge for one day from the chronic hip sinus secondary to revision THA that had been performed 6 years ago, for which he had received multiple courses of debridement, antibiotics, and implant retention procedures owing to periprosthetic joint infection (PJI). DIAGNOSES Radiographs showed septic loosening of both the femoral and acetabular components, with medial migration of the component beyond Kohler's line. Contrast-enhanced computed tomography angiogram of the abdomen and pelvis of the patient demonstrated a large PA of the right external iliac artery (EIA), measuring 6.1 cm × 7.7 cm in diameter and 9.1 cm in length. INTERVENTIONS A ball-shaped antibiotic-loaded cement spacer (ALCS) was used to tamponade a bleeding PA, treat the coexisting PJI, and thus facilitate endovascular stent-graft repair (ESGR) later on. OUTCOMES The ESGR resulted in complete exclusion of the PA and successfully controlled the bleeding. The patient underwent a successful revision THA 6 months after stent insertion. Neither stent-graft infection nor recurrent PJI were detected at 18 months. LESSONS Given the potential of a PA for causing significant morbidity and mortality, the surgeon should have an elevated index of suspicion in the presence of intrapelvic migration of the acetabular component. While facing a PA rupture with/without hemorrhagic shock in patients with coexisting hip PJI, ALCS ball implantation and subsequent ESGR might be an effective method to save the patient's life and limb.
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Affiliation(s)
- Jiun-Liang Chen
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County
| | - Tien-Yu Yang
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Po-Yao Chuang
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Tsan-Wen Huang
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Kuo-Chin Huang
- Department of Orthopedic Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County
- Chang Gung University College of Medicine, Taoyuan City, Taiwan
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Anastasopoulos PP, Lepetsos P, Leonidou AO, Gketsos A, Tsiridis E, Macheras GA. Intra-abdominal and intra-pelvic complications following operations around the hip: causes and management-a review of the literature. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 28:1017-1027. [PMID: 29435655 DOI: 10.1007/s00590-018-2154-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/06/2018] [Indexed: 01/08/2023]
Abstract
Although successful and well-established procedures, hip operations whether elective or trauma are coupled with a variety of complications. Among the most uncommon complications are injuries to intra-abdominal or intra-pelvic organs which could prove potentially life-threatening. While there are various reports of such injuries in the literature, we aimed to perform a systematic review in order to examine the causes and relationships between intra-abdominal and intra-pelvic complications and the mechanism of injury, the pattern of presentation, identification, the course of management and outcomes. We identified 69 reports describing a total of 84 complications in intra-pelvic and intra-abdominal contents in 75 patients. These involved six major categories, including the intestinal tract, the urinary tract, the genital tract, the vascular system, the viscera and peripheral nerves. The most commonly injured system was the urinary (33.33%), followed by the vascular (29.76%) and the intestinal (22.62%). Among these systems, the most prevalent complications involved injury to the urinary bladder (32.14%), the large intestine (68.42%) and the external iliac artery (44%). The majority of recorded complications were postoperative with 71 incidents in 63 cases (84.52%). In intra-operative complications the most prevalent injury was due to hardware penetration (53.85%), while in postoperative it was due to hardware migration (92.06%). The management of injuries varied widely, with the most common approach being open exploration and direct repair (77.33%). The reported management outcomes included death (8%) and Girdlestone resection (2.67%), while the majority of the patients healed uneventfully (82.67%) owing mostly to immediate intervention. Despite being rare, such complications may still occur in a variety of settings and may subsequently lead to potential life-threatening situations. Thus, in order to avoid catastrophic outcomes we emphasize the need for prompt identification, immediate intervention and a multidisciplinary approach when necessary.
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Affiliation(s)
| | - Panagiotis Lepetsos
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Nikis 2, Kifissia, 14561, Athens, Greece.
| | - Andreas O Leonidou
- Third Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, RingRoad, N. Efkarpia, 56403, Thessaloníki, Greece
| | - Anastasios Gketsos
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Nikis 2, Kifissia, 14561, Athens, Greece
| | - Eleftherios Tsiridis
- Third Academic Department of Orthopaedics and Trauma, Aristotle University Medical School, RingRoad, N. Efkarpia, 56403, Thessaloníki, Greece
| | - George A Macheras
- 4th Department of Trauma and Orthopaedics, KAT Hospital, Nikis 2, Kifissia, 14561, Athens, Greece
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Alshameeri Z, Bajekal R, Varty K, Khanduja V. Iatrogenic vascular injuries during arthroplasty of the hip. Bone Joint J 2015; 97-B:1447-55. [DOI: 10.1302/0301-620x.97b11.35241] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vascular injuries during total hip arthroplasty (THA) are rare but when they occur, have serious consequences. These have traditionally been managed with open exploration and repair, but more recently there has been a trend towards percutaneous endovascular management. We performed a systematic review of the literature to assess if this change in trend has led to an improvement in the overall reported rates of morbidity and mortality during the last 22 years in comparison with the reviews of the literature published previously. We found a total of 61 articles describing 138 vascular injuries in 124 patients. Injuries because of a laceration were the most prevalent (n = 51, 44%) and the most common presenting feature, when recorded, was bleeding (n = 41, 53.3%). Delay in diagnosis was associated with the type of vascular lesion (p < 0.001) and the clinical presentation (p = 0.002). Open exploration and repair was the most common form of management, however percutaneous endovascular intervention was used in one third of the injuries and more constantly during the last 13 years. The main overall reported complications included death (n = 9, 7.3%), amputation (n = 2, 1.6%), and persistent ischaemia (n = 9, 7.3%). When compared with previous reviews there was a similar rate of mortality but lower rates of amputation and permanent disability, especially in patients managed by endovascular strategies. Cite this article: Bone Joint J 2015;97-B:1447–55.
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Affiliation(s)
- Z. Alshameeri
- Addenbrooke’s, Cambridge University Hospitals
NHS Trust, Box 37, Hills
Road, Cambridge CB2 0QQ, UK
| | - R. Bajekal
- Barnet Hospital, Royal
Free Hospital NHS Foundation Trust, Hertfordshire, UK
| | - K. Varty
- Addenbrooke’s, Cambridge University Hospitals
NHS Trust, Box 37, Hills
Road, Cambridge CB2 0QQ, UK
| | - V. Khanduja
- Addenbrooke’s, Cambridge University Hospitals
NHS Trust, Box 37, Hills
Road, Cambridge CB2 0QQ, UK
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Total hip arthroplasty revision in case of intra-pelvic cup migration: designing a surgical strategy. Orthop Traumatol Surg Res 2011; 97:191-200. [PMID: 21371962 DOI: 10.1016/j.otsr.2010.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 09/26/2010] [Accepted: 10/21/2010] [Indexed: 02/02/2023]
Abstract
Intrapelvic acetabular cup migration is a rare but serious complication, which can occur after cup loosening following total hip arthroplasty. To make safe intrapelvic implant removal, several principles must be respected: identification of potential risks with a thorough preoperative workup, preoperative planing of a surgical strategy for removing protruding hardware without injuring noble anatomical structures, preserving muscle and bone stock, pelvic anatomy reconstruction (including, as needed, osteosynthesis of the pelvis), and prosthetic components selection correcting any length discrepancy. Preoperative assessment is based on a complete radiological workup, angio-CT, as well as studies searching for signs of inflammation (blood workup and joint aspiration). All cases of intrapelvic migration of an acetabular component do not systematically command a subperitoneal approach. The presence of some residual bone shell, an intrapelvic foreign body, or a path deviation from normal in a vascular bundle or an ureter must be analyzed before deciding on the approach. The potential problems managing this mode of loosening event are a reminder for the need of periodical total hip arthroplasty follow-up. This regular monitoring helps preventing complications sometimes life threatening.
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Sawbridge D, O'Connor OJ, MacEneaney P, Maher MM, Fitzgerald E. Successful Endovascular Treatment of an Infected External Iliac Pseudoaneurysm with Hemorrhage at Total Hip Arthroplasty. J Vasc Interv Radiol 2010; 21:1135-6. [DOI: 10.1016/j.jvir.2010.03.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 03/02/2010] [Accepted: 03/13/2010] [Indexed: 11/29/2022] Open
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