Neurovascular Injury in Hip Arthroplasty / 대한고관절학회지

Neurological and vascular complications following hip arthroplasty are uncommon, and their impact ranges from transient and trivial to permanent and devastating. The proximity of neural and vascular structures makes any operation on the hip potentially hazardous. Direct or indirect injuries of these structures may occur during operative exposure and subsequent procedures. Thus, complete awareness of the anatomy of the pelvis and proximal femur is required. Peripheral nerve injuries can involve either distant sites or nerves in the immediate vicinity of the hip joint. Sciatic nerve injury is the most common nerve injury following total hip arthroplasty. Femoral nerve injury is much less common and is associated with an anterior approach. Its diagnosis is often delayed, but the prognosis is generally better than with sciatic nerve injury. The superior gluteal nerve is at risk during the direct lateral approach. Obturator nerve injury is the least common type of injury and has the least functional consequences. Vascular injuries are less common but more immediately life threatening. The mechanisms of vascular injury include occlusion associated with preexisting peripheral vascular disease and vascular injury during removal of cement during screw fixation of acetabular components, cages, or structural grafts. It is critical to avoid the anterior quadrants for acetabular screw fixation. All acetabular and femoral defects should be bone-grafted to avoid inadvertent cement migration. Following these guidelines, surgeons should be able to offer the most appropriate treatment and counseling to the patients.

Deep Vein Thrombosis and Neurovascular Injury after Total Hip Arthroplasty / 대한고관절학회지

Deep vein thrombosis (DVT) is a relatively common complication of total hip arthroplasty. DVT can accompany symptoms of pain and swelling of the lower leg, and can lead to fatal pulmonary thromboembolism. Surgical procedure is a primary risk factor, and obesity, medical status of disease, or patient's factors could be related. Diagnostic modalities include venography, Doppler ultrasound, CT angiography, and magnetic resonance venography. Mechanical prophylaxis, such as compression stocking and use of an intermittent pneumatic compression device or a pharmacological agent, such as Warfarin, low molecular weight heparin, thrombin inhibitors, and factor Xa inhibitor can be useful. Neurovascular injury after total hip arthroplasty is an uncommon complication, but can be disastrous and fatal. To prevent this complication, the surgeon must be well acquainted with the anatomy and proper surgical skill is needed.