Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants

Abstract

Aims Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anato-my deformed by the intrapelvic implants. Conclusion The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients.