Advertisement

Intra-abdominal and intra-pelvic complications following operations around the hip: causes and management—a review of the literature

  • Panagiotis P. Anastasopoulos
  • Panagiotis Lepetsos
  • Andreas O. Leonidou
  • Anastasios Gketsos
  • Eleftherios Tsiridis
  • George A. Macheras
General Review • HIP - ARTHROPLASTY
  • 44 Downloads

Abstract

Although successful and well-established procedures, hip operations whether elective or trauma are coupled with a variety of complications. Among the most uncommon complications are injuries to intra-abdominal or intra-pelvic organs which could prove potentially life-threatening. While there are various reports of such injuries in the literature, we aimed to perform a systematic review in order to examine the causes and relationships between intra-abdominal and intra-pelvic complications and the mechanism of injury, the pattern of presentation, identification, the course of management and outcomes. We identified 69 reports describing a total of 84 complications in intra-pelvic and intra-abdominal contents in 75 patients. These involved six major categories, including the intestinal tract, the urinary tract, the genital tract, the vascular system, the viscera and peripheral nerves. The most commonly injured system was the urinary (33.33%), followed by the vascular (29.76%) and the intestinal (22.62%). Among these systems, the most prevalent complications involved injury to the urinary bladder (32.14%), the large intestine (68.42%) and the external iliac artery (44%). The majority of recorded complications were postoperative with 71 incidents in 63 cases (84.52%). In intra-operative complications the most prevalent injury was due to hardware penetration (53.85%), while in postoperative it was due to hardware migration (92.06%). The management of injuries varied widely, with the most common approach being open exploration and direct repair (77.33%). The reported management outcomes included death (8%) and Girdlestone resection (2.67%), while the majority of the patients healed uneventfully (82.67%) owing mostly to immediate intervention. Despite being rare, such complications may still occur in a variety of settings and may subsequently lead to potential life-threatening situations. Thus, in order to avoid catastrophic outcomes we emphasize the need for prompt identification, immediate intervention and a multidisciplinary approach when necessary.

Keywords

Intra-abdominal Intra-pelvic Complications Hip 

Notes

Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Compliance with ethical standards

Conflicts of interest

All authors declare that they have no conflict of interest.

References

  1. 1.
    Kurtz S, Ong K, Lau E, Mowat F, Halpern M (2007) Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am 89:780–785PubMedGoogle Scholar
  2. 2.
    Registry NJ (2012) National Joint Registry for England and Wales 9th Annual Report, NJRGoogle Scholar
  3. 3.
    Mundi S, Pindiprolu B, Simunovic N, Bhandari M (2014) Similar mortality rates in hip fracture patients over the past 31 years. Acta Orthop 85:54–59CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Johnson EC, Horwood J, Gooberman-Hill R (2014) Conceptualising time before surgery: the experience of patients waiting for hip replacement. Soc Sci Med 116:126–133CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Awbrey BJ, Wright PH, Ekbladh LE, Doering MC (1984) Late complications of total hip replacement from bone cement within the pelvis: a review of the literature and a case report involving dyspareunia. J Bone Joint Surg Br 66:41–44CrossRefPubMedGoogle Scholar
  6. 6.
    Bach CM, Steingruber I, Wimmer C, Ogon M, Frischhut B (2000) False aneurysm 14 years after total hip arthroplasty. J Arthroplasty 15:535–538CrossRefPubMedGoogle Scholar
  7. 7.
    Bakker KW, Gast LF (1990) Retroperitoneal haemorrhage from the superior gluteal artery: a late complication of total hip arthroplasty. Clin Rheumatol 9:249–253CrossRefPubMedGoogle Scholar
  8. 8.
    Benoni G, Montgomery A, Mansson P, Sanzen L (1995) Laparoscopic extraction of a displaced LIH pin: a case report. Acta Orthop Scand 66:443–444CrossRefPubMedGoogle Scholar
  9. 9.
    Chana-Rodriguez F, Villanueva-Martinez M, Crego-Vita D, Rojo-Manaute J, Vaquero-Martin J (2013) Stoppa approach, an alternative for total hip arthroplasty in an intra-pelvic cup. J Arthroplasty 28:198e191–198e194CrossRefGoogle Scholar
  10. 10.
    Cohen MS, Warner RS, Fish L, Johanson KE, Farcon E (1977) Bladder perforation after orthopedic hip surgery. Urology 9:291–293CrossRefPubMedGoogle Scholar
  11. 11.
    Durao C, Barros A, Guerreiro R, Pedrosa F (2015) “Death by a thread” Peritonitis due to visceral perforation by a guide wire, during proximal femur osteosynthesis with DHS: a fatal case and legal implications. Forensic Sci Int 249:e12–e14CrossRefPubMedGoogle Scholar
  12. 12.
    Evans RP, Nelson JP (1992) Intrapelvic extraction of a total hip prosthesis: a case report. Clin Orthop Relat Res 282:154–157Google Scholar
  13. 13.
    Fischer SR, Christ DJ, Roehr BA (1999) Sciatic neuropathy secondary to total hip arthroplasty wear debris. J Arthroplasty 14:771–774CrossRefPubMedGoogle Scholar
  14. 14.
    Fokter SK, Repse-Fokter A, Takac I (2009) Case report: femoral neuropathy secondary to total hip arthroplasty wear debris. Clin Orthop Relat Res 467:3032–3035CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Foster S, Chaudhary H, Assenmacher B (2009) Intrapelvic cementless component extraction with immediate triflange acetabular reconstruction using the retroperitoneal approach. J Arthroplasty 24:323.e321–323.e325CrossRefGoogle Scholar
  16. 16.
    Goyal S, Moss MC, Breusch SJ (1997) Venous outflow obstruction 8 years following Ring total hip arthroplasty: a rare complication of acetabular loosening and polyethylene wear. Acta Orthop Scand 68:67–69CrossRefPubMedGoogle Scholar
  17. 17.
    Greenspan A, Norman A (1978) Gross hematuria: a complication of intrapelvic cement intrusion in total hip replacement. AJR Am J Roentgenol 130:327–329CrossRefPubMedGoogle Scholar
  18. 18.
    Hopkins NF, Vanhegan JA, Jamieson CW (1983) Iliac aneurysm after total hip arthroplasty: surgical management. J Bone Joint Surg Br 65:359–361CrossRefPubMedGoogle Scholar
  19. 19.
    Hwang SK (1994) Vascular injury during total hip arthroplasty: the anatomy of the acetabulum. Int Orthop 18:29–31CrossRefPubMedGoogle Scholar
  20. 20.
    Isiklar ZU, Lindsey RW, Tullos HS (1997) Sciatic neuropathy secondary to intrapelvic migration of an acetabular cup: a case report. J Bone Joint Surg Am 79:1395–1397CrossRefPubMedGoogle Scholar
  21. 21.
    Jones AL, Acher P, Cynk M (2011) Vesico-acetabular cutaneous fistula: a delayed complication of hip surgery. Urology 78:323–324CrossRefPubMedGoogle Scholar
  22. 22.
    Karaman I, Kafadar IH, Oner M, Halici M (2013) Intrapelvic pin migration after Salter innominate osteotomy and laparoscopic removal: a case report. J Pediatr Orthop B 22:533–535CrossRefPubMedGoogle Scholar
  23. 23.
    King PM, Crawshaw HM, Ross AH (1983) Small bowel volvulus following total hip replacement. Br J Surg 70:100CrossRefPubMedGoogle Scholar
  24. 24.
    Kirkpatrick JS, Callaghan JJ, Vandemark RM, Goldner RD (1990) The relationship of the intrapelvic vasculature to the acetabulum. Implications in screw-fixation acetabular components. Clin Orthop Relat Res 258:183–190Google Scholar
  25. 25.
    Kleinman SZ, Russin LA (1980) Migration of left hip pin with involvement of left ureter. Urology 16:396–397CrossRefPubMedGoogle Scholar
  26. 26.
    Korovesis P, Siablis D, Salonikidis P, Sdougos G (1988) Abdominal-hip joint fistula. Complicated revision of total hip arthroplasty for false aneurysm of external iliac artery: a case report. Clin Orthop Relat Res 231:71–75Google Scholar
  27. 27.
    Kottmeier S, Born CT, Saul H (1993) Laparoscopic retrieval of a migrating intrapelvic pin: case report and review of the literature. J Trauma 35:952–955CrossRefPubMedGoogle Scholar
  28. 28.
    Krocker D, Perka C (2010) Transvaginal emergence of a broken cup marker ring 21 years after total hip arthroplasty. J Arthroplasty 25:660–669CrossRefPubMedGoogle Scholar
  29. 29.
    Kumar S, Singh SK, Jayant K, Agrawal S, Parmar KM, Ajjoor Shankargowda S (2014) Forgotten Kirschner wire causing severe hematuria. Case Rep Urol 2014:305868PubMedPubMedCentralGoogle Scholar
  30. 30.
    Leunig M, Meyer M, Beck M, Triller J, Stupnicki A, Zimmermann H (2001) Fatal retroperitoneal hemorrhage caused by perforation of a guidewire pin for proximal femur fixation. Arch Orthop Trauma Surg 122:61–63CrossRefGoogle Scholar
  31. 31.
    Levin JS, Rodriguez AA, Luong K (1997) Fistula between the hip and the sigmoid colon after total hip arthroplasty: a case report. J Bone Joint Surg Am 79:1240–1242CrossRefPubMedGoogle Scholar
  32. 32.
    Li R, Chen B, Wang G, Ren G, He X, Jia Y (2012) Removal of an intra-abdominal Kirschner wire under digital subtraction angiography: a pediatric case report. J Pediatr Orthop B 21:164–166CrossRefPubMedGoogle Scholar
  33. 33.
    Mak KH, Wong TK, Poddar NC (2001) Wear debris from total hip arthroplasty presenting as an intrapelvic mass. J Arthroplasty 16:674–676CrossRefPubMedGoogle Scholar
  34. 34.
    Makar RR, Salem A, McGee H, Campbell D, Bateson P (2007) Endovascular treatment of bleeding external iliac artery pseudo-aneurysm following control of haemorrhage with Sengstaken tube during revision total hip arthroplasty. Ann R Coll Surg Engl 89:W4–W7CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Marya KM, Yadav V, Rattan KN, Kundu ZS, Sangwan SS (2006) Unusual K-wire migration. Indian J Pediatr 73:1107–1108CrossRefPubMedGoogle Scholar
  36. 36.
    Matsumoto K, Hukuda S, Nishioka J, Fujita T (1992) Iliopsoas bursal distension caused by acetabular loosening after total hip arthroplasty. A rare complication of total hip arthroplasty. Clin Orthop Relat Res 279:144–148Google Scholar
  37. 37.
    McCallum TJ, O’Connor GJ, Allard MJ (1996) Intravesical methylmethacrylate after revision hip arthroplasty. J Urol 156:1777CrossRefPubMedGoogle Scholar
  38. 38.
    McGiffin DC, Dodsworth JM, Thynne GS (1981) Perforation of the sigmoid colon by an orthopedic nail: report of a case. Dis Colon Rectum 24:196–197CrossRefPubMedGoogle Scholar
  39. 39.
    Michel AG, Haskell S (1977) Small bowel obstruction after total hip replacement: a case report. J Bone Joint Surg Am 59:1115CrossRefPubMedGoogle Scholar
  40. 40.
    Murphy IG, Quinlan W, Kelly E (2008) Intraabdominal migration of a dynamic hip screw. Injury Extra 39:230–231CrossRefGoogle Scholar
  41. 41.
    Nonomura M, Kanaoka T, Soeda A, Matsuo M (1994) A case of a methylmethacrylate foreign body in the bladder wall. Int J Urol 1:278–280CrossRefPubMedGoogle Scholar
  42. 42.
    O’Sullivan AW, O’Malley KJ, Fitzpatrick JM, Smith JS (2001) Migration of a prosthetic acetabulum into the bladder. J Urol 166:617CrossRefPubMedGoogle Scholar
  43. 43.
    O’Toole GC, Madhavan P, Shanik G, Fenelon GC (2004) Purulent bloody drainage after infected total hip arthroplasty: a sign of a leaking mycotic aneurysm. J Arthroplasty 19:391–394CrossRefPubMedGoogle Scholar
  44. 44.
    Palmer SW, Luu HH, Finn HA (2003) Hip-vagina fistula after acetabular revision. J Arthroplasty 18:533–536CrossRefPubMedGoogle Scholar
  45. 45.
    Puranen J, Koivisto E (1978) Perforation of the urinary bladder and small intestine caused by a trochanteric plate. Acta Orthop Scand 49:65–67CrossRefPubMedGoogle Scholar
  46. 46.
    Ramkumar U, Saffar N, Thinakarajan TR, Parmar HV (2006) Pelvic migration of lag screw from a nailing device. Injury Extra 37:53–55CrossRefGoogle Scholar
  47. 47.
    Ray B, Baron TE, Bombeck CT (1979) Bladder and ureteral displacement complication of total replacement hip arthroplasty. Urology 13:554–556CrossRefPubMedGoogle Scholar
  48. 48.
    Reigstad A, Rokkum M (1992) An intrapelvic granuloma induced by acetabular cup loosening. Acta Orthop Scand 63:465–466CrossRefPubMedGoogle Scholar
  49. 49.
    Ridley MG, Price TR, Grahame R, Jourdan M, Watson M (1985) Colocutaneous fistula as late complication of total hip replacement in rheumatoid arthritis. J R Soc Med 78:951–952CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Roberts JA, Loudon JR (1987) Vesico-acetabular fistula. J Bone Joint Surg Br 69:150–151CrossRefPubMedGoogle Scholar
  51. 51.
    Robinson D, Alk D, Bass A, Siegel Y, Halperin N (2003) Total hip replacement via a combined intra and extra-pelvic approach causing dysuria and bladder penetration. Isr Med Assoc J 5:528–529PubMedGoogle Scholar
  52. 52.
    Rodriguez PM, Marin MR, Marin-Blazquez AA (2010) Image of the month: perforation of the colon through a hip prosthesis. Clin Gastroenterol Hepatol 8:A26CrossRefPubMedGoogle Scholar
  53. 53.
    Russell RD, Incavo SJ, Mineo MT, Dinh T (2010) Vesicoacetabular fistula in a chronically infected total hip arthroplasty. J Arthroplasty 25:659.e9–659.e12CrossRefGoogle Scholar
  54. 54.
    Schafer D, Mattarelli G, Morscher E (1994) Ureteroarticular fistula after total hip replacement: a case report. Arch Orthop Trauma Surg 114:35–36CrossRefPubMedGoogle Scholar
  55. 55.
    Schneider W, Knahr K (1997) Bladder fistula after loosening of a cementless self-cutting acetabular component—a case report. Acta Orthop Scand 68:601–602CrossRefPubMedGoogle Scholar
  56. 56.
    Seitz WH Jr, Berardis JM, Giannaris T, Schreiber G (1982) Perforation of the rectum by a Smith-Petersen nail. J Trauma 22:339–340CrossRefPubMedGoogle Scholar
  57. 57.
    Shafi M, Kim WY, Han CH, Ji JH, Lee SM (2006) Intrapelvic migration of a well-fixed femoral stem after removal of an acetabular cup. J Arthroplasty 21:922–925CrossRefPubMedGoogle Scholar
  58. 58.
    Tauber M, Resch H (2006) Sigmoid perforation after medial migration of lag screw in gamma nailing. Arch Orthop Trauma Surg 126:118–122CrossRefPubMedGoogle Scholar
  59. 59.
    Tazawa A, Nakamura S, Otsuka K, Nishida K, Matsushita T (2001) Transabdominal approach for intrapelvic migration of a total hip prosthesis component. J Orthop Sci 6:362–365CrossRefPubMedGoogle Scholar
  60. 60.
    Thein E, De Canniere A, Burn A, Borens O (2014) Medial migration of lag screw after gamma nailing. Injury 45:1275–1279CrossRefPubMedGoogle Scholar
  61. 61.
    Thienpont E, Vernaeve H (2003) Reactive pelvic cyst following total hip arthroplasty: a case report. Acta Orthop Belg 69:292–294PubMedGoogle Scholar
  62. 62.
    Tkaczuk H (1976) False aneurysm of the external iliac artery following hip endoprosthesis. Acta Orthop Scand 47:317–319CrossRefPubMedGoogle Scholar
  63. 63.
    Tomak Y, Gulman B, Malazgirt Z, Karaismailoglu TN (2001) Severe pelvic pain and extrinsic compression of the rectum: late complication of total hip arthroplasty. J Orthop Sci 6:282–285CrossRefPubMedGoogle Scholar
  64. 64.
    Tripp BM, Tanzer M, Laplante MP, Elhilali MM (1995) Vesico-acetabular fistula. J Urol 153:1910–1911CrossRefPubMedGoogle Scholar
  65. 65.
    Van Mourik JB, Josaputra HA, Axler A (1988) Giant synovial cyst causing deep venous thrombosis: brief report. J Bone Joint Surg Br 70:841CrossRefPubMedGoogle Scholar
  66. 66.
    Venkata GR, Mootha AK, Thayi C, Parekh VG, Ramireddy VK (2012) Concomitant laparoscopy: an effective technique for successful retrieval of intra pelvic migrated broken guide pin. Injury 43:526–529CrossRefPubMedGoogle Scholar
  67. 67.
    Vishwanath J, Ng YP, Teo YS, De SD (2007) Vesico-hip fistula from bladder puncture with subsequent infected total hip arthroplasty. J Arthroplasty 22:939–941CrossRefPubMedGoogle Scholar
  68. 68.
    Wangen H, Hemstad L, Jonsson H, Talsnes O (2012) Spontaneous and uncomplicated anal elimination of a hip pin—a case report. Acta Orthop 83:420–422CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Wheeler JS Jr, Babayan RK, Austen G Jr, Krane RJ (1983) Urologic complications of hip arthroplasty. Urology 22:499–503CrossRefPubMedGoogle Scholar
  70. 70.
    Woolson ST, Maloney WJ, Tanner JB (1989) External iliac arteriovenous fistula following total hip arthroplasty: a case report. J Arthroplasty 4:281–284CrossRefPubMedGoogle Scholar
  71. 71.
    Wooten SL, McLaughlin RE (1984) Iliacus hematoma and subsequent femoral nerve palsy after penetration of the medical acetabular wall during total hip arthroplasty: report of a case. Clin Orthop Relat Res 191:221–223Google Scholar
  72. 72.
    Robinson SJ, Fountain JR, Torella F, Pennie BH (2011) Intrapelvic migration of a lag screw from a cephalomedullary femoral nail: a case report. Injury 42:1384–1386CrossRefPubMedGoogle Scholar
  73. 73.
    Johri V, Gupta V (2013) Orthopaedic guide wire injury to ileum in a case of fracture neck of femur. Indian J Surg 75:36–37CrossRefPubMedGoogle Scholar
  74. 74.
    Bach CM, Steingruber IE, Ogon M, Maurer H, Nogler M, Wimmer C (2002) Intrapelvic complications after total hip arthroplasty failure. Am J Surg 183:75–79CrossRefPubMedGoogle Scholar
  75. 75.
    Feeney M, Masterson E, Keogh P, Quinlan W (1997) Risk of pelvic injury from femoral neck guidewires. Arch Orthop Trauma Surg 116:227–228CrossRefPubMedGoogle Scholar
  76. 76.
    Freitas A, Souto DRdM, Leite PRA et al (2010) Abdominal injuries due to the use of guide wire in hip surgery experiments: cadaveric study. Acta Ortopédica Brasileira 18:75–78CrossRefGoogle Scholar
  77. 77.
    Siegel A, Schulz F, Puschel K (2001) Fatal pelvic vein injury caused by guidewire used with the dynamic hip screw. Unfallchirurg 104:182–186CrossRefPubMedGoogle Scholar
  78. 78.
    Wasielewski RC, Cooperstein LA, Kruger MP, Rubash HE (1990) Acetabular anatomy and the transacetabular fixation of screws in total hip arthroplasty. J Bone Joint Surg Am 72:501–508CrossRefPubMedGoogle Scholar
  79. 79.
    Feugier P, Fessy MH, Bejui J, Bouchet A (1997) Acetabular anatomy and the relationship with pelvic vascular structures: implications in hip surgery. Surg Radiol Anat 19:85–90CrossRefPubMedGoogle Scholar
  80. 80.
    Shoenfeld NA, Stuchin SA, Pearl R, Haveson S (1990) The management of vascular injuries associated with total hip arthroplasty. J Vasc Surg 11:549–555CrossRefPubMedGoogle Scholar
  81. 81.
    Hariri S, Rubash H (2006) Retroperitoneal approach for revision total hip arthroplasty. In: Barrack RL, Rosenberg AG (eds) Master techniques in orthopaedic surgery: the hip, vol 17, 2nd edn. Lippincott-Raven, PhiladelphiaGoogle Scholar
  82. 82.
    Johanson NA, Pellicci PM, Tsairis P, Salvati EA (1983) Nerve injury in total hip arthroplasty. Clin Orthop Relat Res 179:214–222CrossRefGoogle Scholar
  83. 83.
    Kleiner JB, Donaldson WF 3rd, Curd JG, Thorne RP (1991) Extraspinal causes of lumbosacral radiculopathy. J Bone Joint Surg Am 73:817–821CrossRefPubMedGoogle Scholar
  84. 84.
    Saal JA, Dillingham MF, Gamburd RS, Fanton GS (1988) The pseudoradicular syndrome. Lower extremity peripheral nerve entrapment masquerading as lumbar radiculopathy. Spine (Phila Pa 1976) 13:926–930CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.4th Department of Trauma and OrthopaedicsKAT HospitalAthensGreece
  2. 2.Third Academic Department of Orthopaedics and TraumaAristotle University Medical SchoolThessaloníkiGreece

Personalised recommendations