Profunda Femoris Pseudoaneurysm following Total Hip Arthroplasty Revision

Abstract

Vascular injuries following total hip arthroplasty (THA) are very rare, with pseudoaneurysm being a small subset. We report a case of profunda femoris artery (PFA) pseudoaneurysm in a 61-year-old male following a posterior approach revision left THA. Presentation involved continued blood transfusion requirements several weeks postoperatively. Diagnosis of the pseduoaneurysm was made by contrast CT of the lower extremity, with confirmation via IR angiography. Successful embolization was achieved with selective coiling and Gelfoam. Presenting complaints of such complications are often vague and therefore lead to delayed diagnosis. Causes of such complications are not completely understood, particularly with PFA injuries in THA. Possible mechanisms are discussed in this paper. Vascular complications following THA can be difficult to diagnose. High suspicion in the setting of continued postoperative pain or bleeding may allow prompt diagnosis and avoidance of serious limb-threatening complications.

Figure 1

AP pelvis of the primary THA showing good alignment without fracture.

Figure 2

AP and lateral of the primary THA showing good alignment without fracture.

Figure 3

X-ray arthrogram showing mild contrast tracking along the proximal lateral aspect of the femoral component.

Figure 4

AP pelvis postoperatively showing good alignment without fracture or femoral cortex perforation.

Figure 5

AP hip postoperatively showing no fracture or femoral cortex perforation.

Figure 6

Contrast CT of the left lower extremity showing a suspected pseudoaneurysm of the left profunda femoris artery.

Figure 7

IR angiogram demonstrating 13 mm pseudoaneurysm of the profunda femoris artery.

Figure 8

Imaging of embolization of the pseudoaneurysm by coiling and Gelfoam, performed by IR.

Figure 9

Angiogram showing coil in profunda femoris artery with elimination of the pseudoaneurysm previously demonstrated.