Mitigation of Vascular Complications in Revision Total Hip Arthroplasty With Intrapelvic Migration of Implants: A Preoperative Algorithmic Approach.

BACKGROUND

Intrapelvic migration of implants or cement following total hip arthroplasty (THA) is a rare, but serious complication that can lead to life-threatening vascular injuries during revision surgery. The close proximity of migrated components to major pelvic vessels markedly increases the risk of intraoperative hemorrhage, necessitating a strategic preoperative and intraoperative approach.

METHODS

This retrospective study evaluated 17 patients undergoing revision THA for intrapelvic implant or cement migration at a tertiary care center between 2020 and 2025. All patients underwent preoperative computed tomography angiography to assess vascular proximity. Patients who had implants or cement within five mm of pelvic vessels underwent preoperative endovascular intervention, either balloon catheter placement (n = 8) for larger vessels or arterial coiling/glue (n = 5) for smaller branches. Intra- and post-operative outcomes, including vascular injuries, blood losses, transfusion needs, and complications, were assessed.

RESULTS

Vascular proximity was identified in 13 of 17 patients. Following our proposed algorithm, endovascular interventions were successfully performed in all 13 patients, without perioperative complications. There was one patient who required balloon inflation intraoperatively to control bleeding, with no subsequent hemodynamic instability or mortality. There were no major vascular injuries or emergency conversions that occurred. The mean blood loss was 1,310 ± 121 mL in the intervention group versus 1,400 ± 248 mL in the nonintervention group. There were three patients who each underwent two-stage procedures and Girdlestone arthroplasties, four who underwent single-stage revision, and three who are awaiting the second-stage procedure.

CONCLUSIONS

A preoperative algorithm incorporating computed tomography angiography and selective endovascular intervention effectively mitigates vascular risks in revision THA with intrapelvic migration. Balloon catheter placement and arterial coiling offer targeted vascular protection, enabling safer surgical execution. This multidisciplinary, algorithmic strategy enhances patient safety and surgical outcomes in complex revision hip arthroplasty.