A swollen leg after total hip arthroplasty

• Published in: Nederlands tijdschrift voor geneeskunde Vol. 152; no. 29; p. 1634
• Main Authors: Kuiken, D S, ten Have, B L E F, van Raay, J J A M
• Format: Journal Article
• Language: Dutch
• Published: Netherlands 19-07-2008
• Subjects: Aged; Arthroplasty, Replacement, Hip - adverse effects; Bursa, Synovial; Constriction, Pathologic - diagnosis; Constriction, Pathologic - etiology; Constriction, Pathologic - surgery; Cysts - complications; Cysts - diagnosis; Cysts - surgery; Decompression, Surgical - methods; Female; Femoral Vein - pathology; Humans; Iliac Vein - pathology; Leg - pathology; Middle Aged; Polyethylene - therapeutic use; Postoperative Complications; Treatment Outcome
• ISSN: 0028-2162

Two patients, a 71-year-old and a 59-year old woman who had undergone total hip arthroplasty, presented with pain, difficulty in walking and slow progressive unilateral leg swelling. They did not have any other physical abnormalities. Physical examination and other investigations indicated a cystic enlargement of the iliopectineal bursa causing venous obstruction of the v. femoralis. After exploration and excision of the swelling the patients recovered rapidly. Pathological examination showed a bursa with an extensive foreign body giant cell reaction, double-breaking fibrous polyethylene and a small quantity of granular metal pigment originating from the total hip prosthesis. A unilateral swelling of the leg can also be caused by deep venous thrombosis and primary lymphatic oedema or by other compressing swellings. Venous obstruction due to cystic enlargement of the iliopectineal bursa following total hip arthroplasty is only described incidentally. Treatment consists of decompression of the affected structures and if necessary revision of the polyethylene cup to avoid excessive polyethylene wear.