JOA - 2026-08-14 - Journal Article
Mitigation of Vascular Complications in Revision Total Hip Arthroplasty with Intra-Pelvic Migration of Implants: A Pre-Operative Algorithmic Approach.
Kumar V, Kabra A, Behera A, Ojha MM, Shankar V, Gamanagatti S
Topics
Key Takeaway
A preoperative algorithm using CTA with selective endovascular intervention (balloon catheter or arterial coiling) in 13 of 17 revision THA patients with intra-pelvic implant migration resulted in zero major vascular injuries and mean blood loss of 1,310 mL.
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Summary
This retrospective study evaluated a preoperative algorithmic approach to vascular risk mitigation in 17 revision THA patients with intra-pelvic implant or cement migration at a single tertiary center from 2020–2025. CTA identified vascular proximity (<5 mm) in 13 patients, all of whom underwent endovascular intervention (balloon catheter n=8, arterial coiling/glue n=5) without perioperative complications. No major vascular injuries or emergency conversions occurred; one patient required intraoperative balloon inflation with no hemodynamic instability, and mean blood loss was 1,310 ± 121 mL in the intervention group versus 1,400 ± 248 mL in the non-intervention group.
Key Limitation
The 17-patient sample from a single tertiary center with no comparative control group or reported surgeon/interventionalist volume data precludes determining whether outcomes reflect the algorithm or institutional expertise.
Original Abstract
BACKGROUND
Intra-pelvic migration of implants or cement following total hip arthroplasty (THA) is a rare, but serious complication that can lead to life-threatening vascular injuries during revision surgery. The close proximity of migrated components to major pelvic vessels markedly increases the risk of intraoperative hemorrhage, necessitating a strategic preoperative and intraoperative approach.
METHODS
This retrospective study evaluated 17 patients undergoing revision THA for intra-pelvic implant or cement migration at a tertiary care center between 2020 and 2025. All patients underwent preoperative computed tomography angiography (CTA) to assess vascular proximity. Patients who had implants or cement within five mm of pelvic vessels underwent preoperative endovascular intervention-either balloon catheter placement (n = 8) for larger vessels or arterial coiling/glue (n = 5) for smaller branches. Intra- and postoperative outcomes, including vascular injuries, blood losses, transfusion needs, and complications, were assessed.
RESULTS
Vascular proximity was identified in 13 of 17 patients. Following our proposed algorithm, endovascular interventions were successfully performed in all 13 patients, without perioperative complications. There was one patient who required balloon inflation intraoperatively to control bleeding, with no subsequent hemodynamic instability or mortality. There were no major vascular injuries or emergency conversions that occurred. The mean blood loss was 1,310 ± 121 mL in the intervention group versus 1,400 ± 248 mL in the non-intervention group. There were three patients who each underwent two-stage procedures and Girdlestone arthroplasties, four who underwent single-stage revision, and three who are awaiting the second-stage procedure.
CONCLUSION
A preoperative algorithm incorporating CTA and selective endovascular intervention effectively mitigates vascular risks in revision THA with intra-pelvic migration. Balloon catheter placement and arterial coiling offer targeted vascular protection, enabling safer surgical execution. This multidisciplinary, algorithmic strategy enhances patient safety and surgical outcomes in complex revision hip arthroplasty.