External Iliac Artery Injury from Migrated Antibiotic Hip Spacer: A Case Report.

Abstract

Vascular injury after total hip arthroplasty is a rare but devastating event1,2 with high morbidity and mortality3 and litigation risk1. Clinical presentations are variable, ranging from obvious swelling4 and limb ischemia5 to hypotension that is unresponsive to resuscitation with fluids and blood6. Factors associated with increased risk of vascular injury after total hip arthroplasty include revision surgery, female sex, and intrapelvic migration of the acetabular components in the setting of periprosthetic joint infection (PJI)6. Intrapelvic migration of an antibiotic-impregnated polymethylmethacrylate spacer in the setting of PJI has similarly been implicated in vascular injury after total hip arthroplasty4. However, to our knowledge, this event previously has been reported only once. We believe that we present the first case of injury to the external iliac artery caused by gradual intrapelvic migration of an antibiotic spacer over several years in the setting of persistent PJI, presenting without obvious symptoms and signs of vascular injury. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. Eight years after left resection total hip arthroplasty and antibiotic spacer placement without reconstruction for PJI, a sixty-nine-year-old woman presented with eight months of increasing left hip pain. The medical history was noteworthy for cervical cancer complicated by lymphedema in both lower extremities and bilateral radiation necrosis of the superior dome of the acetabulum. On physical examination, she was afebrile and normotensive with tachycardia. The incision from the previous surgery appeared well healed, although the entire left lower extremity was swollen, consistent with the baseline. Able to walk both indoors and outdoors for most activities, she had a positive log roll test but would not allow any hip range of motion because of pain; she was neurovascularly …