Cement fragment from hip arthroplasty causing deep femoral artery pseudoaneurysm

An 81-year-old woman who had undergone total hip arthroplasty 12 years earlier presented with a painful spontaneous hematoma in the proximal left thigh. A left hip radiograph showed a displaced cement fragment from the acetabular component of the hip prosthesis. Computed tomography confirmed an extruded cement fragment causing a large pseudoaneurysm of the deep femoral artery. The patient underwent successful percutaneous embolization of the pseudoaneurysm with coils.

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Retrograde Cement Extrusion into Femoral Nutrient Vessels Following Uncomplicated Total Hip Arthroplasty

IIUM Medical Journal Malaysia ◽

10.31436/imjm.v16i1.1176 ◽

2017 ◽

Vol 16 (1) ◽

Author(s):

Lim Chia Hua ◽

V.A. Jacob ◽

N. Premchandran

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Artery ◽

Femoral Stem ◽

Deep Femoral Artery ◽

Neck Of Femur ◽

Term Survival ◽

Stem Size ◽

Total Hip ◽

Femoral Cortex

The present concepts in Total Hip Arthroplasty advocate mechanical cement interlock with trabecular bone utilising the third-generation cementing technique. However, the force generated can easily reach peak pressure of 122 kPa to 1500 kPa, leading to extrusion of cement through nutrient foramina into femoral cortex into nutrient vessels, henceforth the retrograde arteriovenogram. A 76 years old lady who premorbid ADLindependent had a fall and sustained a closed right neck of femur fracture. She underwent cemented right total hip arthroplasty. Acetabulum cup of 47mm and femoral stem size 1 was utilized. Femoral canal was prepared and medullary cavity plug inserted before retrograde cement was introduced using the cementing gun. Intraoperative no complications were noted. This case has been followed up to a year with no adverse effect. The post-operative radiograph demonstrated a linear radio-opacity communicating with the posterior aspect of the femoral shaft which continues proximally and medially for approximately 10cm. Its uniformity in shape and position corresponds to the vascular supply of proximal femur. In Farouk et al cadaveric study, nutrient vessel arises in 166 ± 10 mm from the greater trochanter and is a branch of the second perforating artery from the deep femoral artery. Knight et al infer that retrograde cement extrusion occurs in female patients with small stature and small endosteal canal. Cement extrusion unlikely will influence the long haul survival of prosthesis as shown in the radiograph that cement is well pressurized to interlock with the endosteal bone. Moreover, because of extensive anastomoses of perforating branches of the deep femoral artery, segmental obliteration of nutrient artery alone is unlikely to lead to vascularity issues. Cement extrusion into the nutrient foramen is a vital differential in presence of posterior medial cement in the diaphysis of the femur following total hip replacement. This is to differentiate from extra osseous extrusions due to the iatrogenic breach of the femoral cortex suggesting periprosthetic fracture which affects the long term survival of prosthesis.

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An unusual complication following total hip arthroplasty: median circumflex femoral artery pseudoaneurysm

Acta Orthopaedica et Traumatologica Turcica ◽

10.3944/aott.2014.3000 ◽

2014 ◽

Vol 48 (1) ◽

pp. 106-108 ◽

Cited By ~ 3

Author(s):

Serhat Mutlu

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Artery ◽

Unusual Complication ◽

Artery Pseudoaneurysm ◽

Total Hip ◽

Circumflex Femoral Artery

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Left Profunda Femoral Artery Pseudoaneurysm After Revision Total Hip Arthroplasty

Arthroplasty Today ◽

10.1016/j.artd.2020.09.004 ◽

2020 ◽

Vol 6 (4) ◽

pp. 906-910

Author(s):

Steven Baker ◽

Mary Kathryn Huddleston ◽

Tyler M. Goodwin ◽

Ryan Voskuil ◽

Case Sanders

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Femoral Artery ◽

Revision Total Hip Arthroplasty ◽

Artery Pseudoaneurysm ◽

Total Hip

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Plasma Prekallikrein Activity in Patients with Total Hip Arthroplasty

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646052 ◽

1987 ◽

Vol 58 (04) ◽

pp. 1040-1042

Author(s):

J J M L Hoffmann ◽

J H J P M Kortmann

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Hip Prosthesis ◽

Contact System ◽

Factor Xii ◽

Total Hip ◽

Activity Factor ◽

Patient Groups ◽

Kallikrein Activity

SummaryThe behaviour of the contact system was studied in 40 patients with total hip arthroplasty, by measuring plasma prekallikrein, spontaneous kallikrein activity and factor XII. In the literature it had been shown that patients with complications from this operation had decreased prekallikrein and increased kallikrein activity (M. Nakahara. Acta orthop scand 1982; 53: 591-6). In the present study, comprising patients with and without pain and proven loosening of the hip prosthesis, these findings could only partially be confirmed. Patients with a loosened prosthesis had significantly lower prekallikrein (mean 0.78 ± 0.28 U/ml; p <0.01) than patients without problems, but no detectable kallikrein activity in plasma. Patients with pain but no loosening had normal prekallikrein (1.04 ±0 0.26 U/ml) and also no demonstrable kallikrein activity. Factor XII was normal in all patient groups. It is concluded that decreased prekallikrein is limited to patients with a loosened hip prosthesis, with or without pain.

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