Pseudoaneurysm rupture with hemorrhagic shock in a patient with periprosthetic hip joint infection

Abstract

Rationale:Although pseudoaneurysm (PA) formation following primary and revision total hip arthroplasty (THA) is rare, PA rupture may lead to severe complications that can result in a threat to life and limb.Patient concerns:A 65-year-old man presented with acute hemorrhagic discharge for one day from the chronic hip sinus secondary to revision THA that had been performed 6 years ago, for which he had received multiple courses of debridement, antibiotics, and implant retention procedures owing to periprosthetic joint infection (PJI).Diagnoses:Radiographs showed septic loosening of both the femoral and acetabular components, with medial migration of the component beyond Kohler's line. Contrast-enhanced computed tomography angiogram of the abdomen and pelvis of the patient demonstrated a large PA of the right external iliac artery (EIA), measuring 6.1 cm × 7.7 cm in diameter and 9.1 cm in length.Interventions:A ball-shaped antibiotic-loaded cement spacer (ALCS) was used to tamponade a bleeding PA, treat the coexisting PJI, and thus facilitate endovascular stent-graft repair (ESGR) later on.Outcomes:The ESGR resulted in complete exclusion of the PA and successfully controlled the bleeding. The patient underwent a successful revision THA 6 months after stent insertion. Neither stent-graft infection nor recurrent PJI were detected at 18 months.Lessons:Given the potential of a PA for causing significant morbidity and mortality, the surgeon should have an elevated index of suspicion in the presence of intrapelvic migration of the acetabular component. While facing a PA rupture with/without hemorrhagic shock in patients with coexisting hip PJI, ALCS ball implantation and subsequent ESGR might be an effective method to save the patient's life and limb.

Life-Threatening, Bleeding Pseudoaneurysm of the External Iliac Artery in the Setting of an Infected Total Hip Arthroplasty from Pasteurella multocida

“…Pseudoaneurysm of the external iliac artery is a well-described complication after THA with several documented case reports and series in the literature [ [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] ]. The most common proposed causes of these pseudoaneurysms are a malpositioned retractor, migration of acetabular cups, and even migrated cement fragmentation after placement of a cemented femoral stem [ 21 , 24 , 25 , 30 ].…”

External iliac pseudoaneurysm secondary to medial wall penetration of an acetabular screw: a rare cause of total hip arthroplasty failure 15 years after implantation

“…External iliac artery PSA can also occur from infection [28], [29], [30], [31], [32], [33], [34], [35], acetabular periprosthetic fracture [30], acetabular component migration [27], [30], [31], [32], [33], [36], intrapelvic extravasation of cement [37], prior irradiation [29], and a prominent osteophyte after revision THA [26]. Acetabular screw irritation of the EIA has previously been implicated in the formation of these lesions, but, to our knowledge, this has been universally described in the setting of component migration, and frequently concurrent infection [23], [27].…”