Common femoral artery transection during total hip arthroplasty for a neglected septic hip dislocation: a case report

Abstract Introduction: Vascular injury during total hip arthroplasty (THA) is a rare but life-threatening complication. Severe anatomical distortion, particularly in complex hip pathology, may substantially increase this risk. Case presentation: A 62-year-old woman with a history of childhood septic arthritis presented with a chronically dislocated hip and advanced joint destruction. During THA, sudden massive hemorrhage occurred during acetabular exposure. Postoperative absence of distal pulses and a sensorimotor deficit raised suspicion of acute limb ischemia. CT angiography confirmed femoral artery occlusion. Emergency vascular exploration revealed complete transection of the common and superficial femoral arteries, which were reconstructed using a PTFE graft. Clinical discussion: Neglected septic hip dislocation profoundly alters local anatomy, bringing major vessels into close proximity to the acetabulum and increasing the risk of vascular injury. Early recognition of abnormal bleeding and postoperative vascular compromise is essential. Close collaboration between orthopedic, anesthesiology and vascular teams is critical to achieving limb salvage and preventing fatal outcomes. Selective use of CT angiography can aid preoperative risk assessment in hips with severe anatomical distortions. Conclusion: Vascular injury during THA is a rare but serious complication. Meticulous surgical technique, systematic postoperative vascular examination, and prompt multidisciplinary intervention are critical to optimize survival and limb salvage.