Vascular risk and total hip arthroplasty prevention during acetabular revision

Purpose of the study Though exceptional, there is a real risk of vascular complications during t otal hip arthroplasty procedures. The gravity of these latrogenic accidents results from their high mortality (7%) and possible functional sequelae (1 9%). Material and method We report a retrospective multicenter study of 14 vascular complications, s ix of which occurred during revision surgery for total hip arthroplasty. We assessed risk factors and identified situations of major risk related to a cetabular revision: intrapelvic dislocation, protrusion with no bony barrie r, and presence of intrapelvic foreign. bodies. We advocate the, retroperit oneal approach for acetabular revision in case of intrapelvic dislocation o r anomalous vessel size or trajectory on the preoperative arteriography. Th is approach allows ablation of the implants under visual control of the ili ac vessels. Results and discussion A careful preoperative work-up is essential to avoid arterial or venous inj ury. A perfect knowledge of the vessel trajectories and their projection on the acetabulum is crucial. Indeed, such vascular complications are never e xpected and transform a well-programmed functional procedure into an emerge ncy procedure with the inherent risks. We recall that such accidents may be expressed well after closing and the importance of careful surveillance be fore, during and after the surgical procedure.