Arterial injury during removal of a migrated acetabular component

Abstract

Vascular trauma after hip surgery has been described mostly after elective total hip arthroplast)~ but there have also been a number of cases after hip fracture surgery. Re-operation increases this risk in elective total hip arthroplastyJ Arterial injury complicating hip replacements are rare 2 and usually occur at the time of operation. Delayed arterial injury may result from a false aneurysm produced when the acetabular floor has been broached by operative instrumentation. Arterial injury can also be caused by the migration of cement or prosthesis into the pelvic cavity. The treatment options for arterial injury include primary repair, a by-pass graft for short segments, or ligation in combination with an extra-anatomic bypass graft. 3'4 Resection of damaged artery and primary end-to-end anastomosis is not usually possible. We report a case where elongation of the artery by migrating acetabular component made such a repair possible. control this and there was continuing acetabular destruction with proximal migration of the prosthesis into the pelvis (Figs 1 and 2). She was admitted for skeletal traction with a view to removing the prosthesis. During admission, she developed a bloody discharge from the hip wound associated with pyrexia and diarrhoea. There was no evidence of a pelvic abscess or false aneurysm on CT scan. Surgery was planned with a vascular surgeon in attendance. Pus was found deep to vastus lateralis, and the acetabular cup was lying deep within the true pelvis. Through a hypogastric incision the pelvic vessels were identified and controlled. The cup was adherent to the external iliac artery with the artery stretched over the protruding acetabular cup (Fig. 2). Manipulation of the prosthesis led to pronounced bleeding from a linear tear in the posterior wall of the