title: Primary ileus after total hip arthroplasty: rare complication or sentinel event?
abstract: The incidence of hip dislocation after primary total hip arthroplasty (THA) has been reported to range from 1 to 25% in THA revision. Here, we explore the hypothesis that there is a correlation between postoperative ileus (POI) and THA dislocation, with POI after THA possibly representing a sentinel event. We retrospectively identified a cohort of 529 consecutive patients who underwent hip arthroplasty from 2008 to 2010. Of them, 251 were male and 278 were female, and a mean average for age of 71.5 (range 65-76). In particular, 19 THA patients showed signs of gastrointestinal complications, and therapeutic consultation was performed with the onset of the first intestinal symptom. Of these 19 patients, 3 THA patients developed POI within 1 week after surgical treatment. A conservative treatment was practised and it seemed to improve the condition: canalization returned and all patients were discharged from the hospital. Unfortunately, two of these patients were readmitted after 2 weeks due to THA dislocation and they underwent THA revision and were discharged from the hospital 7 days later. Follow-up revealed no further problems at 6 months. Our clinical experience with these post-THA primary ileus patients raises the possibility that intra-abdominal symptoms represent a sentinel event in THA dislocation. THA dislocation using neuronal pathway of immunomodulation may modulate POI. Since the risk of THA dislocation is the greatest in the first 3 months after hip arthroplasty, the surgeon should be familiar with the relationship between THA and various pelvic and visceral complications to ensure that POI remains only a rare complication.
authors.affiliation: Division of General Surgery B, Foundation IRCCS Istituto Nazionale dei Tumori, Via G. Venezian, 1, 20133, Milan, Italy. a.vannelli@tiscalinet.it
authors.forename: Alberto
authors.initials: A
authors.lastname: Vannelli
authors.forename: Domenico
authors.initials: D
authors.lastname: Laveneziana
authors.forename: Mario
authors.initials: M
authors.lastname: Rampa
authors.forename: Luigi
authors.initials: L
authors.lastname: Battaglia
authors.forename: Ermanno
authors.initials: E
authors.lastname: Leo
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D013997:Time Factors