Internal iliac artery injury and total hip arthroplasty: discovery after 10 years.

Delayed presentation of iliac artery injury by acetabular screw. Screw removal at liner revision of a 10-year-old uncemented acetabular shell resulted in unexpected catastrophic blood loss. Replacing the screw prevented further hemorrhage, and investigation revealed internal iliac artery injury caused by the screw. This was treated successfully by bypass grafting. Careful review of preoperative imaging should aim to identify those at risk and requiring further imaging before undergoing revision surgery.