[Arterial trauma in hip arthroplasty].

INTRODUCTION

Arterial injuries due to total hip arthroplasty can be a serious complication. The risk of vascular injury is related to proximity of the structures, tractions, and the aggressive use of instruments.

OBJECTIVES

To analyze the frequency, injury mechanism, clinical presentation and therapeutic options in this kind of injury.

PATIENTS AND METHOD: A group of 4162 patients subjected to total hip arthroplasty between 1986 and 2006 (reinterventions 7.2%). We describe 8 cases (5 women and 3 men) with a mean age of 61 years (reinterventions 50%). The vascular surgery was performed at less than 1 hour (n = 4), 6 hours (n = 2), 16 hours (n = 1) and 20 days (n = 1).

RESULTS

The most frequent locations were external iliac artery (n = 3), common femoral (n = 3), internal iliac (n = 1) and deep femoral (n = 1). The clinical presentation was, internal bleeding (50%), acute limb ischemia (37%) and subacute limb ischemia (13%). The surgical interventions were bypass (50%), arteriorrhaphy (25%), primary repair (12.5%), and thrombectomy and patching (12.5%). One case was reoperated 6 years later, as we found a false anastomotic aneurism in a previous ilio-femoral bypass. The death and amputation rates were 0%.

CONCLUSIONS

Although these injuries are rare, they involve a life-threatening complication. The external iliac artery/common femoral artery are the most frequent location. Most patients required a bypass, although the surgical technique depends on the injury location.