Total Hip Replacement Interrupted by Intraoperative Cardiac Arrest with a Final Component in Place: A Case Report

No consensus recommendations exist as to the management of implants exposed during an interrupted total hip arthroplasty (THA). Given the infrequency of such events, documentation of successful outcomes in single case reports aids in decision-making. A ۷۱-year-old male with a history of coronary artery disease and a BMI of ۳۹.۵ went into ventricular fibrillation half-way through a THA, after placement of a cementless acetabular component but before femoral preparation could begin. Continuation of the planned arthroplasty was aborted, the patient’s wound was packed with sterile sponges and covered with an iodoform dressing, and he was flipped supine for CPR. He returned to the OR ۶-hours following his arrest and his arthroplasty was completed with the original acetabular implant left in place. The patient was placed empirically on ۲ weeks of IV vancomycin and ۳ months of oral doxycycline based on infectious disease recommendations, and healed uneventfully. While validation of our strategy is challenging due to the infrequent nature of this event, it is hoped that this description and discussion may provide a template to those who encounter a similar challenging situation.

Keywords:

Intraoperative arrest , Arthroplasty , contaminated implants , Antibiotic Prophylaxis