Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Dec 18, 2017; 8(12): 964-967
Published online Dec 18, 2017. doi: 10.5312/wjo.v8.i12.964
Acute compartment syndrome of the thigh following hip replacement by anterior approach in a patient using oral anticoagulants
Dirk Pieter Hogerzeil, Imraan Muradin, Eline W Zwitser, Joris A Jansen
Dirk Pieter Hogerzeil, Imraan Muradin, Eline W Zwitser, Joris A Jansen, Department of Orthopedic Surgery, Alrijne Hospital, Leiderdorp, GA 2353, The Netherlands
Author contributions: All authors contributed to the acquisition of the writing and revision of this manuscript.
Informed consent statement: The participating patient in this case report provided informed consent and gave permission for publication of the case.
Conflict-of-interest statement: None of the authors have any conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dirk Pieter Hogerzeil, MD, Department of Orthopedic Surgery, Alrijne Hospital, Simon Smitweg 1, Leiderdorp, GA 2353, The Netherlands. dphogerzeil@alrijne.nl
Telephone: +31-6-22376633
Received: September 21, 2017
Peer-review started: September 22, 2017
First decision: November 7, 2017
Revised: November 13, 2017
Accepted: December 3, 2017
Article in press: December 3, 2017
Published online: December 18, 2017
Processing time: 87 Days and 18.1 Hours
Abstract

Acute compartment syndrome (ACS) of the thigh following primary total hip arthroplasty (THA) is a highly uncommon complication and has not yet been reported before with regards to the anterior approach through the anterior supine interval. We present a case of a 69-year-old male patient with a history of stroke, who developed ACS of the thigh after elective THA while using therapeutic low molecular weight heparin as bridging for regular oral anticoagulation. ACS pathogenesis, diagnostic tools, treatment and relevant literature are discussed. The patient’s ACS was recognized in time and treated by operative decompression with fasciotomy of the anterior compartment. Follow-up did not show any neurological deficit or soft-tissue damage.

Keywords: Orthopedics; Total hip arthroplasty; Anterior supine intermuscular approach; Acute compartment syndrome; Anticoagulation therapy

Core tip: Acute compartment syndrome of the thigh is an uncommon complication following total hip arthroplasty, which has not yet been reported after hip replacement by anterior approach through the anterior supine interval. Global increase in venous thromboembolism chemoprophylaxis may lead to an increase in incidence of postoperative bleeding and with this an increase in acute compartment syndrome of the thigh following primary total hip arthroplasty. Onset of severe pain of the upper leg postoperatively should warrant a high index of suspicion of this condition. Diagnostic tools such as ultrasound, computed tomography or intra-compartmental pressure measurements can be useful but should not lead to any delay of treatment.