Persistent Bladder Entrapment Following Acetabular Fracture with Subsequent Vesical Injury During Total Hip Arthroplasty

Abstract

M ost urological injuries encountered by orthopaedic surgeons are associated with pelvic trauma. Acute injuries to the bladder, prostate, and urethra may occur in association with 13.5% to 46.6% of pelvic fractures1-3. Bladder ruptures account for the majority of these injuries4 and typically occur in association with high-energy trauma, such as motor-vehicle accidents, falls, industrial accidents, or abdominal blows5,6. While bladder rupture is much more common, three cases of acute bladder entrapment after pelvic fracture have been reported in the English-language literature4,7,8. Urological injuries following primary total hip arthroplasty are also infrequent. In patients with cemented acetabular components, acute injuries to the bladder can occur as the result of medial wall perforation or cement extrusion9,10 or in association with cement and component extraction during revision surgery11. In patients with uncemented acetabular components, acute urologic or gastrointestinal injuries can occur as a result of errant drill-bit or screw placement12. Late presentation of urologic complications has been reported as a consequence of medial migration of an acetabular component12,13. In the present report, we describe the case of a patient who had had a previous acetabular fracture that had healed with an unrecognized bladder entrapment and who sustained a penetrating bladder injury during primary total hip replacement. To our knowledge, injury of an entrapped bladder during hip arthroplasty has not been previously reported. The patient was informed that data concerning this case would be submitted for publication. A forty-three-year-old man was admitted to our institution for a right total hip arthroplasty. He had severe progressive mechanical pain in the right hip and a limited walking distance. Twenty years earlier, he had been involved in a motor-vehicle accident …