Uchida Kenzo, Negoro Kohei, Kokubo Yasuo, Yayama Takafumi, Miyazaki Tsuyoshi, Nakajima Hideaki, Yoshida Ai, Baba Hisatoshi
Departments of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka-Shimoaizuki 23-3, Eiheiji, Fukui, 910-1193, Japan.
J Med Case Rep. 2012 Sep 13;6:294. doi: 10.1186/1752-1947-6-294.
Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period.
We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day) for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement.
Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.
全髋关节置换术中，髋臼杯固定螺钉穿透髋臼内侧壁所导致的血管并发症并不少见，但在术后晚期很少会引发严重不良事件。
我们报告一例77岁日本女性患者，在全髋关节置换术后13年出现髋臼进行性广泛骨质吸收和巨大血肿。入院时，她因房颤正在口服华法林（1.5mg/天）。在开始抗凝治疗约5个月后，她发生了一次严重跌倒，随后出现大量皮下和骨盆带出血，主要集中在右大腿内侧，但急诊骨科评估未发现全髋关节置换术有骨折或损伤迹象。事故发生一年后，常规随访检查显示右骨盆髋臼有一个无症状溶骨性病变，两年后患者在行走时注意到右髋部逐渐疼痛。X线平片显示右髋臼有一个大的溶骨性病变。在高分辨率计算机断层扫描和磁共振成像中，髋臼内一个巨大肉芽肿性病变提示盆腔内和盆腔外臀区有慢性血肿。更仔细的计算机断层扫描检查显示，全髋关节置换术中用于固定髋臼组件的一枚螺钉穿透了髋臼骨并进入盆腔。通过两种手术入路一次性完成手术：经腹前正中入路切除低密度肿块病变，随后行髋臼后外侧假体重新安置。
尽管罕见，但全髋关节置换术相关的晚期血管并发症可能很严重，并可能影响肢体和生活质量。
