Total Hip Arthroplasty in Extensive Venous Malformations: An Experience of Four Cases

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Background: Extensive venous malformation (VM) (Klippel-Trenaunay syndrome, KTS) and associated degenerative joint disease of the hip is a rare condition. The difficulty of total hip replacement (THR) depends on tissue involvement around the joint, with the risk of severe blood loss. To evaluate the feasibility and outcome of hip replacement in this disease. Methods: Between 2010 and 2020, 4 patients with extensive VM of the limb and degenerative joint disease had a total hip replacement. Investigations included X-ray exams, T2 MRI with fat saturation, and hematologic tests. The main outcome end- points of the study were success of hip replacement, postoperative complications and quality of life. Results: Four patients underwent THR. Le sex ratio was (3 males, 1 female) with a median age of 37 years (range 27-55). All were symptomatic, with worsening hip pain and use of a mechanical aid. MRI identified VM in the muscles and cellular space of the buttock. The choice of surgical approach was anterior in three patients, and lateral in one. Mean blood loss was 1500mL. Surgery was completed by peroperative sclerotherapy to reduce blood loss (3 patients). The median follow-up time was 82 months (range 12- 120). There were no postoperative complications. At 6 months, three patients were walking with normal gait, and one was using an orthopedic walker after knee arthrodesis. There was no reoperation during the follow-up. All patients returned to their professional activities. Conclusion: The difficulty of total hip replacement depends on the extent of involved soft tissue around the hip area. The choice of surgical approach, surgical skill in vascular and orthopedic procedures and per-operative sclerotherapy permit to reduce surgical risk.