Beguin L, Feugier P, Durand J M, Chalencon F, Gresta G, Fessy M H
Centre d'Orthopédie-Traumatologie, Pavillon 1-3, Hôpital Bellevue, CHRU de Saint-Etienne, 42055 Saint-Etienne Cedex 2.
Rev Chir Orthop Reparatrice Appar Mot. 2001 Sep;87(5):489-98.
Though exceptional, there is a real risk of vascular complications during total hip arthroplasty procedures. The gravity of these iatrogenic accidents results from their high mortality (7%) and possible functional sequelae (19%).
We report a retrospective multicenter study of 14 vascular complications, six of which occurred during revision surgery for total hip arthroplasty. We assessed risk factors and identified situations of major risk related to acetabular revision: intrapelvic dislocation, protrusion with no bony barrier, and presence of intrapelvic foreign bodies. We advocate the retroperitoneal approach for acetabular revision in case of intrapelvic dislocation or anomalous vessel size or trajectory on the preoperative arteriography. This approach allows ablation of the implants under visual control of the iliac vessels.
A careful preoperative work-up is essential to avoid arterial or venous injury. A perfect knowledge of the vessel trajectories and their projection on the acetabulum is crucial. Indeed, such vascular complications are never expected and transform a well-programmed functional procedure into an emergency procedure with the inherent risks. We recall that such accidents may be expressed well after closing and the importance of careful surveillance before, during and after the surgical procedure.
