Six patients who had a total hip replacement, as well as a trochanteric
osteotomy, while they were in the lateral decubitus position had
complications involving the contralateral side. The complications included
transient paresthesias, massive swelling of the thigh with myonecrosis,
acute renal failure secondary to myoglobinuria, and arterial insufficiency
that resulted in a below-the-knee amputation. In order to elucidate the
causes of the complications, the external pressure of the contralateral
femoral triangle and the blood flow to the contralateral foot were
monitored intraoperatively in seventeen patients. The results supported the
postulate that pressure at the groin is increased intraoperatively and that
this can cause vascular compromise. Other proposed causes of the
complications were pre-existing vascular disease, obesity, the lateral
decubitus position of the patient on the operating table, and the use of
hypotensive anesthesia. We found several techniques that may minimize
complications in the contralateral limb during operations on the hip.