Coloarticular fistula: A rare complication of revision total hip arthroplasty

Abstract

Fistula formation between bowel and total hip arthroplasty or revision arthroplasty hardware is rare. We present a case of a 78-year-old woman with protrusio of left hip arthroplasty and acetabular reconstruction hardware that caused direct perforation of the sigmoid colon and fistula formation between the sigmoid colon and the left hip joint. The patient underwent several joint debridements, sigmoid colectomy, and removal of all orthopedic hardware; she ultimately died after two prolonged hospitalizations.

Keywords: CT, computed tomography.

Figure 1

Frontal radiographs of the pelvis after (A) initial total hip arthroplasty in 1998, (B) revision bipolar arthroplasty and acetabular graft in 2008, and (C) acetabular reconstruction and placement of antiprotrusio cage in 2009 showing progressive medial migration of the left acetabular and femoral hardware and left pubic rami insufficiency fractures.

Figure 2

CT examination of the abdomen and pelvis on admission. (A) CT scout image demonstrates multiple dilated loops of small bowel from ileus and severe protrusio of the acetabular and femoral hardware. (B) Coronal and (C) axial CT images of the pelvis show complete discontinuity of the medial acetabular wall, and a hook-shaped flange of the acetabular cage traversing the sigmoid colon wall (arrow).

Figure 3

Intraoperative photograph demonstrates the proximity of the penetrating flange of the acetabular cup (arrowhead) to the left external iliac artery (arrow). Note the stapled proximal sigmoid colon (asterisk).