Femoral artery injury during total hip arthroplasty

An, Shuai; Shen, Huiliang; Feng, Mingli; Zheng, Lirong; Cao, Guanglei

doi:10.1016/j.artd.2018.03.003

Cited by 16 publications

(16 citation statements)

References 38 publications

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“…puncture injuries or arterial lacerations), iii) false aneurysms, and iv) heat induced arterial thrombosis due to polymerization of bone cement. (4,(6)(7)(8) Clinical signs and symptoms of these injuries can arise within the immediate post-operative period, or in a delayed fashion as demonstrated by our case. The most common manifestations of vascular injuries include intraoperative haemorrhage, post-operative ischaemic symptoms from impaired flow or acute thrombosis, or delayed joint pain and soft tissue swelling from pseudoaneurysms.…”

Section: Discussionmentioning

confidence: 56%

A novel case of a pseudoaneurysm due to thermal injury from a cement hip spacer

Boer

Shiraev

Dubenec

2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Section: Discussionmentioning

confidence: 56%

A novel case of a pseudoaneurysm due to thermal injury from a cement hip spacer

Boer

Shiraev

Dubenec

2021

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…Intrapelvic acetabular screw penetration during THA is known to be potentially hazardous with serious and often immediate associated complications [ [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] ]. While mispositioned acetabular screws typically have acute or subacute implications, intrapelvic screw penetration may also be problematic remote from the index procedure [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…The placement of transacetabular screws is recognized to have associated risk, and close attention must be paid to the extrapelvic acetabular quadrant in which these are placed [ [6] , [7] , [8] , [9] ]. A multitude of complications have been reported with aberrant screw placement including arterial laceration, [ 10 ] arterial pseudoaneurysm formation, [ [11] , [12] , [13] , [14] ] bladder injury, [ 15 ] and nerve irritation, [ 16 ] among others [ 17 ]. Arterial injury, in particular, during THA has been reported to occur in 0.08%-0.3% of cases [ [18] , [19] , [20] , [21] ].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues

Wilson¹,

Pflederer²,

Schwartz³

et al. 2021

Arthroplasty Today

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Background Intraoperative vascular injury during total hip arthroplasty represents a catastrophic complication. Acetabular screw placement represents one possible mode of injury. The purpose of this study was to evaluate the utility of various fluoroscopic views in the detection of intrapelvic screw penetration. Methods A radiopaque pelvis Sawbones model was instrumented with a hemispherical acetabular component. Four intrapelvic quadrants were defined. Screws were placed, 3 in each quadrant, and imaged sequentially at 3 depths: 0 mm, 5 mm, and 10 mm penetrated. Eight fluoroscopic images were used: anteroposterior, inlet, outlet, iliac oblique, obturator oblique, “down the wing,” obturator outlet, and a “quad” view. Three blinded, independent surgeons evaluated the images for intrapelvic screw penetration. Images were analyzed in isolation and as a “triple-shot series” consisting of the “quad,” obturator outlet, and iliac oblique views. Sensitivity and specificity values were then calculated. Results In isolation, the “quad” view had the highest sensitivity for screw penetration (62%). The triple-shot series was found to be 100% sensitive in all 4 quadrants for detecting 10 mm of screw penetration. The specificity of the series was found to be 100% in all quadrants except for the posterior superior quadrant where it was 67%. Interobserver agreement approached perfection (Kappa ≥0.947) between all surgeons ( P < .001) when using the 3-view series. Conclusions This study is the first to assess the use of fluoroscopy in the detection of intrapelvic penetration of transacetabular screws. We found that a 3-radiograph series provided a sensitive and specific metric for the detection of intrapelvic screw penetration.

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“…[ 4 ] It occurs frequently in female patients and on the left side in arthroplasty, which reflects the closer proximity of the vessels to the hip joint in these 2 categories. [ 5 ] However, Shuai et al [ 6 ] described that other factors such as the type of surgery (infection or revision) might be more important for the vascular injury. Abularrage et al [ 7 ] reported an increase in the incidence of 0.04% in primary THA to 0.19% in revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Massive venous air embolism with bleeding caused by femoral vein injury during total hip arthroplasty

et al. 2021

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Introduction: Venous air embolism (VAE) from vascular injuries, is of rare occurrence but can result in catastrophic complications during total hip arthroplasty (THA). Early recognition and prompt management of vascular injury are required to avoid severe complications. Especially, bleeding is generally associated with profound hypotension in venous injury. We report an unusual complication of venous air embolism induced by femoral vein rupture during THA. Patient concerns: A 54-year-old male patient with a history of old left acetabular fracture was scheduled for THA. We experienced massive bleeding and VAE induced by femoral vein rupture during total hip arthroplasty. The BP suddenly dropped from 100/70 mm Hg to 80/50 mm Hg with massive bleeding. ETCO 2 and SaO 2 decreased profoundly. Diagnosis: The VAE was diagnosed by the change in end- tidal CO 2 (ETCO 2 ) and change of vital signs, so we performed ABGA and inserted TEE for confirmination. Interventions: For treatment, patient was managed by oxygen therapy, inotropics, vasopressor, transfusion and surgical repair. Outcomes: Upon consulting with a cardiologist, the patient was extubated the next day and was transferred to the general ward and recovered without serious complications. He stayed for 17 days until finally discharged without complications Conclusion: Preoperative vascular imaging may be recommended in the revisional case of THA or in patients with the history of hip trauma. The monitoring of ETCO 2 and TEE might be helpful to recognize VAE earlier and therefore to avoid catastrophic complications through adequate treatment.

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Femoral artery injury during total hip arthroplasty

Cited by 16 publications

References 38 publications

A novel case of a pseudoaneurysm due to thermal injury from a cement hip spacer

A novel case of a pseudoaneurysm due to thermal injury from a cement hip spacer

Intraoperative Radiographic Detection of Intrapelvic Acetabular Screw Penetration: Lessons Learned From Our Trauma Colleagues

Massive venous air embolism with bleeding caused by femoral vein injury during total hip arthroplasty

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