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.