Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

Journal of Medical Case Reports

Hisatoshi Baba¹  Ai Yoshida¹  Hideaki Nakajima¹  Tsuyoshi Miyazaki¹  Takafumi Yayama¹  Yasuo Kokubo¹  Kohei Negoro¹  Kenzo Uchida¹ 

[1]Departments of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, Matsuoka-Shimoaizuki 23-3, Eiheiji, Fukui, 910-1193, Japan

关键词: Revision surgery;    Bone resorption;    Retroperitoneal hematoma;    Total hip arthroplasty;   

Others  :  1195435
DOI  :  10.1186/1752-1947-6-294

 received in 2012-02-19, accepted in 2012-07-31,  发布年份 2012

【 摘 要 】

Introduction

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.

Case presentation

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.

Conclusions

Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.

【 授权许可】

   
2012 Uchida et al.; licensee BioMed Central Ltd.

【 图 表 】

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