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
ARTICLE HIGHLIGHTS
Case characteristics

A 69-year-old male presented with severe pain, swelling, hematoma and paresthesia of the right leg following elective total hip replacement by anterior approach.

Clinical diagnosis

Severe pain, swelling and hematoma of the upper leg, as well as paresthesia of the lower leg.

Differential diagnosis

Postoperative pain, postoperative dislocation of the hip, periprosthetic fracture, iatrogenic neurological damage.

Laboratory diagnosis

Preoperative international normalized ratio was 1.3 and Hemoglobin level 9.4 g/dL, postoperative Hemoglobin levels were 7.0 g/dL and 3.9 g/dL.

Imaging diagnosis

Ultrasound of the thigh showed an intramuscular hematoma of the anterior compartment of 8.3 cm by 3.5 cm and computed tomography revealed two hematomas of the anterior compartment.

Pathological diagnosis

Cultures of the surgical site showed no infection.

Treatment

Venous thromboembolism (VTE) prophylaxis was discontinued and an emergency fasciotomy through the anterior compartment of the thigh was performed during which a large hematoma was evacuated, the surgical site was extensively irrigated with normal saline solution and tranexamic acid was administered topically in the wound.

Related reports

Acute compartment syndrome is a known complication often following trauma such as fractures or crush injuries. However, a highly uncommon presentation and localization of acute compartment syndrome is that of the thigh following total hip replacement by the anterior approach. The first symptoms of acute compartment syndrome of the thigh can easily be confused with other causes for postoperative pain, swelling, hematoma and paresthesia.

Term explanation

Acute compartment syndrome is defined by increased pressure in a closed fascial space compromising the circulation to the nerves and muscles within the involved compartment. VTE prophylaxis is a mechanical or pharmacologic method for prevention of venous thromboembolism.

Experiences and lessons

Acute compartment syndrome of the thigh is a highly uncommon complication following total hip replacement by anterior approach and as such should and must be considered in case of postoperative onset of severe pain of the upper leg.