Extensive skin necrosis following total hip arthroplasty performed through the direct anterior approach

Article Article scientifique Rapport de cas Extensive skin necrosis following total hip arthroplasty performed through the direct anterior approach eng 2023-06-23 2023-06-23 author Idris Nimatullah Tolulope Department of Orthopaedic Surgery, Geneva University Hospitals & Faculty of Medicine, Avenue Gabrielle Perret Gentil 4, Geneva, 1205, Switzerland. 835896 author Zingg Matthieu Department of Orthopaedic Surgery, Geneva University Hospitals & Faculty of Medicine, Avenue Gabrielle Perret Gentil 4, Geneva, 1205, Switzerland. 632362 author Gauthier Morgan Department of Orthopaedic Surgery, Geneva University Hospitals & Faculty of Medicine, Avenue Gabrielle Perret Gentil 4, Geneva, 1205, Switzerland. 670219 author Oranges Carlo Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals & Faculty of Medicine, Geneva, Switzerland. 955344 author Kalbermatten Daniel Department of Plastic, Reconstructive and Aesthetic Surgery, Geneva University Hospitals & Faculty of Medicine, Geneva, Switzerland. 948183 Département de chirurgie (CHIRU) Daniel Felix Kalbermatten author Hannouche Didier 0000-0003-2060-2394 Department of Orthopaedic Surgery, Geneva University Hospitals & Faculty of Medicine, Avenue Gabrielle Perret Gentil 4, Geneva, 1205, Switzerland. didier.hannouche@hcuge.ch. 842478 Département de chirurgie (CHIRU) 516 10.1186/s12891-023-06643-z 37353761 1471-2474 PMC10288717 https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-023-06643-z Background: Total hip arthroplasty is a widely performed surgical procedure, which enables patients to regain mobility, alleviates pain, and improves overall quality of life. Periarticular multimodal drug infiltration (PAI) is increasingly being used as an effective postoperative pain management, decreasing the systemic consumption of opioids. Extensive postoperative skin necrosis without a deep joint infection as a complication of total hip arthroplasty with PAI has not yet been described. Case presentation: A 71-year-old patient who underwent total hip arthroplasty of the right hip for primary osteoarthritis through the Direct Anterior Approach presented postoperatively a large area of necrotic skin at the incision. Joint infection was excluded. An extensive debridement was performed and the tissue defect was reconstructed by a pedicled anterolateral thigh flap. The skin maintained a satisfactory appearance at 1 year postoperatively, and the hip was pain-free with restored ranges of motion. The patient was able to walk with no support and without limitation. Conclusion: We address the possible risk factors, discuss the use of epinephrine in PAI and explore possible treatment options for such a complication. Anterolateral thigh flap Periarticular infiltration (PAI) Skin necrosis Total hip arthroplasty (THA) Wound complication Humans Aged Arthroplasty, Replacement, Hip / adverse effects Quality of Life Skin Analgesics, Opioid Arthritis, Infectious Necrosis / etiology Necrosis / surgery Treatment Outcome Dewey 617 57 Département de chirurgie 222 false 955 Mécanismes physiopathologiques de l'arthrose 960 1343 Reconstruction chirurgicale et régénération des tissus 1029 BMC musculoskeletal disorders 24 1 de500f6e-4f33-48d1-9289-ff17f638793c Article (Published version) Public Article-scientifique-from-europePmc.pdf 1240815 application/pdf CC BY-4.0 ca2305979c680b0f759c1483164e64c0f008acefc223203afd35c1537ea559eb d59334ae-ef51-48e3-bb4d-2f3211627936 Appendix Public 12891_2023_6643_MOESM1_ESM.pdf 719574 application/pdf CARE Checklist of information to include when writing a case report d7810d20cfc66711b133f5589b179a5558a89d16a32eda1ed6568fb4df1e98f0 030de58c-3b83-48ba-af01-0853b80d47cb Appendix Public 12891_2023_6643_MOESM2_ESM.mov 6483612 video/quicktime dd38fe575a713874251f9f6c21d93c9e2eb305cd995556ffa5aa87add0a17c2f openAccess Faculté de médecine / Section de médecine clinique / Département de chirurgie

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Extensive skin necrosis following total hip arthroplasty performed through the direct anterior approach	BMC musculoskeletal disorders			2023	107	149

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Idris, Nimatullah Tolulope