Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants

Abstract

Aims Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. Conclusion The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients. Cite this article: Bone Jt Open 2022;3(11):859–866.

Re-revision and mortality rate following revision total hip arthroplasty for infection

“…The highest impact in changing the process of care is likely to be achieved by improvements in the perioperative care, treatment in high-volume centres, standardized antibiotic regimes, preoperative cardiopulmonary assessment, readily available intensive care facilities, and specialist teams of surgeons and physicians highly experienced in the multidisciplinary care these patients require. 37,38 As shown in registry data, hospitals with higher case numbers perform above average, with reduced re-revision rates and lower mortality. It is likely that patients with PJI will achieve better results if treated in specialist units who can meet the care requirements highlighted.…”

Prevention of Pernicious Vascular Event: Acetabular Component Screw Impinging on External Iliac Vessels – A Unique Case Report

“…About 40% of vascular injuries around the hip are reported to occur during RTHA [ 2 ]. The majority of them occurred during intrapelvic implant removal and were most commonly associated with metallosis, peri-implant fibrosis, and infection [ 2 ].…”

“…About 40% of vascular injuries around the hip are reported to occur during RTHA [ 2 ]. The majority of them occurred during intrapelvic implant removal and were most commonly associated with metallosis, peri-implant fibrosis, and infection [ 2 ]. In addition, inflammatory response around the implants makes the vessel more adherent and non-resilient, making it prone to damage.…”

“…The incidence increases to 0.2% in revision THA (RTHA) cases, with the external iliac and the common femoral vessels being the most injured [ 1 ]. The associated 15% morbidity and 7% mortality [ 2 ] require surgeons to understand how to recognize, confirm, and effectively manage such injuries to prevent life-threatening situations.…”

“…[ 3 ]. The external iliac, gluteal, obturator, and femoral vessels are at a higher risk of injury due to proximity to the acetabulum [ 2 ].…”