The Journal of Bone and Joint Surgery, Vol 61, Issue 1 24-27, Copyright © 1979 by Journal of Bone and Joint Surgery, Inc
Ischemia of the lower extremity after total hip replacement
MH Matos, HC Amstutz and HI Machleder
Following total hip replacement, three patients had early and one had late
ischemia of the ipsilateral extremity. Three required vascular surgery and
one, a lumbar sympathectomy for relief of pain at rest. In each instance
there had been multiple previous procedures on the same hip resulting in
extensive scarring, shortening, flexion contracture, or fusion. The
ischemia after total hip replacement was probably the result of
interruption of critical collateral circulation about the hip or of
traction on the femoral vessels tethered by scar when the short limb was
lengthened or when the hip contracture was corrected. Evaluation by Doppler
pressures and arteriography was helpful. Careful preoperative evaluation,
early recognition of signs of ischemia, and prompt institution of
appropriate management are essential to prevent this complication and to
treat it adequately once it occurs.
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