Priapism as a Complication after Total Hip Arthroplasty: A Case Report and Review of the Literature

Abstract

Priapism is defined as a prolonged engorgement or erection of the penis or clitoris that is unrelated to sexual arousal. Recent studies have determined the incidence of priapism to be between 1.5 and 2.9 per 100,000 person years. The incidence of priapism following elective orthopedic surgery is rare. Defining the etiology of a case of postoperative priapism following orthopedic surgery can be difficult, and many times cannot be determined. This case represents the first report of priapism following an elective total hip arthroplasty (THA) performed under spinal anesthesia, and focuses on a review of the literature and potential etiologies of this rare complication. A 44-year-old man with a history of right hip osteoarthritis underwent elective minimally invasive cementless right THA under spinal anesthesia (1 mg of Intrathecal Morphine and 100 mg of intravenous Fentanyl) without initial complication. A preoperative Foley catheter was placed without incident and the patient was placed into the left lateral decubitus position. Surgical time was recorded at 60 minutes. Nine hours after the Foley catheter was removed, the patient developed a persistent painless erection. Successful emergent treatment included a penile Winter shunt, to irrigate blood from the corpora. A computed tomography scan of the pelvis ruled out pelvic deep vein thrombosis as an etiology. This case represents the first report of priapism after an elective THA. The incidence of priapism as a complication is well described and has been associated with numerous medical conditions discussed in this article.