A Late Vascular Complication Due to Component Migration After Revision Total Hip Arthroplasty

Abstract 

Although vascular injuries associated with primary and revision total hip arthroplasty are infrequent, these complications can have devastating effects that can lead to morbidity and even mortality. No previous reports have described embolic distal limb ischemia secondary to a failed and migrated acetabular implant in discontinuity with the pelvis. We present a novel case in which a screw from a failed and migrated acetabular cage construct led to injury of the superficial femoral artery. While awaiting the construction of a custom prosthesis, the patient developed thromboembolism leading to distal extremity ischemia. The patient was treated with thrombolytic therapy, anticoagulation, removal of the offending hardware, forefoot amputation, and later hip reconstruction. Recognition of the risks associated with failed and migrated components may prevent this complication in the future.

Keywords: vascular injury, embolic ischemia, revision total hip arthroplasty, amputation