Multidisciplinary approach to the treatment of patients with periprosthetic joint infection of the hip complicated by injury to the great vessels

Abstract

Introduction Total counts of total hip arthroplasty (THA) have been increasing for several decades, and the procedures are associated with considerable risk of intra- and postoperative complications. Vascular complications are defined as multiple pathological conditions. They are subdivided into acute adverse events such as intraoperative bleeding, acute ischemia and hematoma and chronic complications such as pseudoaneurysms and arteriovenous fistulas which can cause late ischemic events. A specialized and well-trained multidisciplinary team is required to perform surgical interventions due to the small number of intravascular lesions. The objective was to demonstrate findings of clinical, instrumentation methods and staged treatment of patients with periprosthetic joint infection (PJI) of the hip and complications associated with injury to the great vessels. Material and methods We report two cases of vascular complications in patients with PJI and migration of femoral components into the lesser pelvis. Results An integrated approach to the diagnosis and treatment of patients with PJI and complications associated with injury to the great vessels helped to avoid lethal outcomes of the Girdlestone operation. Discussion Revision THA requires careful planning and an interdisciplinary approach with the help of a clinical pharmacologist, microbiologist, plastic or angiosurgeon. PJI is associated with a high risk of recurrence that would require two-stage, three-stage surgical interventions. With the bone deficiency of the acetabulum and the proximal femur the Girdlestone operation is performed as the final procedure with resultant significant decrease in the functional adaptation of patients. Conclusion Careful preoperative preparation of patients with unstable hip replacement components including migration of the acetabular component into the pelvic cavity and associated PJI would help to avoid such a devastating complication as great vessel injury.

Keywords

• revision arthroplasty
• vascular injury
• periprosthetic joint infection of the hip
• girdlestone operation