VASCULAR COMPLICATIONS IN TOTAL HIP-REPLA CEMENT

The vascular anatomy in the acetabular region involves a certain risk of arterial and venous injuries complicating orthopaedic surgery. Thes e complications have been grouped into four categories: lacerations, t hrombosis. pseudoaneurysms and arteriovenous fistula. In a period of 5 years. three injuries of the external iliac artery and four lesions o f the femoral artery associated with total hip arthroplasty were treat ed surgically at the Department of Vascular Surgery of the University Hospital in Graz. In one case a concomitant lesion of the pelvic vein was observed. The incidence of iatrogenic vascular injuries in total h ip surgery is 0.3%. Combined injury of the external iliac artery and v ein led to a life-threatening bleeding complication. The vascular lesi on became manifest as acute ischaemia of the lower extremity or as an acute haemorrhage 30 min to 2 h after primary surgery. The late compli cation of a false aneurysm of the femoral artery occurred in one patie nt 3 weeks after total hip replacement. Reconstruction of the vascular lesions was performed by direct suture, except that two arterial lesi ons required the use of polytetrafluoroethylene (PTFE) vascular grafts . Vessels in the pelvic region are at high risk if screw fixation acet abular components are used. Perforation of the iliac artery by protrud ed methylmethacrylate polymer components of cement has been documented . The obturator vessels are in a vulnerable position if the acetabular floor has been broached by operative instruments or eroded by looseni ng of tile prosthesis facilitated by osteoporosis, steroids or sepsis. Femoral vessels are endangered by Hohmann retractors that are not pla ced directly on bone. Though vascular injury during hip operations is rare, recognition of such complications is important as safe and satis factory treatment call be achieved. Rapid identification and immediate surgical repair of these lacerations are essential for their manageme nt.