title: A rare case of arterial avulsion presenting with occult blood loss following total hip arthroplasty: a case report.
abstract: BACKGROUND
  Iatrogenic arterial damage during total hip replacement is a rare but potentially life- or limb-threatening complication. To the best of our knowledge, this is the first reported case of an avulsion injury to a posterior branch of the profunda femoral artery during primary hip arthroplasty.
  
  
  METHODS
  We describe the case of a 55-year-old Caucasian man who underwent a total hip replacement. The patient's hemoglobin levels dropped postoperatively, but there was no obvious bleeding, hemodynamic instability, pulsatile mass, or limb ischemia. The patient's hemoglobin levels continued to drop despite nine units of transfused blood. Three days after surgery, the patient underwent an angiography that showed an avulsion injury to a posterior branch of the profunda femoral artery. The avulsion was ligated and the hematoma was evacuated.
  
  
  CONCLUSIONS
  Vascular damage may present in many ways including obvious bleeding, haemodynamic instability, a pulsatile mass, limb ischemia, and occult blood loss. Any of these signs in isolation or in combination could represent a vascular injury and an urgent angiogram should be considered.
authors.affiliation: Department of Trauma & Orthopaedics, North Manchester General Hospital, Crumpsall Street, Manchester, M8 5RB, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Hall
authors.forename: Wasim S
authors.initials: WS
authors.lastname: Khan
authors.forename: Sohail I
authors.initials: SI
authors.lastname: Ahmed
authors.forename: David H
authors.initials: DH
authors.lastname: Sochart