Dislocation of Total Hip Replacement Prosthesis After Transarterial Embolization of A Pseudoaneurysm: Case Report

Dislocation of Total Hip Replacement Prosthesis After Transarterial Embolization of A Pseudoaneurysm: Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Dislocation of Total Hip Replacement Prosthesis After Transarterial Embolization of A Pseudoaneurysm: Case Report Hsu-Chao Chang, Chia-Hung Lu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8357281/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background Pseudoaneurysm is a rare complication after total hip replacement (THR). Prosthesis dislocation following embolization of a pseudoaneurysm is even more uncommon. We report a case of prosthesis dislocation after embolization of a pseudoaneurysm and discuss its possible underlying mechanisms. Case Presentation We report the case of an 83-year-old woman who developed a right medial femoral circumflex artery pseudoaneurysm one month after THR, for which she underwent emergent transarterial embolization (TAE). One day after the procedure, she returned to the emergency department with a THR dislocation. Computed tomography (CT) imaging confirmed enlargement of the pseudoaneurysm and its transformation into a hematoma after TAE, resulting in increased mass effect and subsequent prosthesis dislocation. The patient underwent open reduction with evacuation of the blood clot and was discharged in stable condition. Conclusion Awareness of the potential short-term progression of a pseudoaneurysm after TAE, and its subsequent transformation into a hematoma—which may increase mass effect—can facilitate early diagnosis when prosthesis dislocation is detected after embolization and guide appropriate management. Total hip replacement (THR) Dislocation Pseudoaneurysm Transarterial embolization (TAE) Case report Figures Figure 1 Figure 2 Background The dislocation rate of primary hip replacements ranges from 0.2% to 10% per year, while that of artificial hip joints that have already been surgically revised can be as high as 28% [ 1 ] . Hematoma following primary total hip replacement (THR) can require a return to the operating room. A hematoma that is large enough to require surgical attention is a complication that occurs in 0.41% of patients undergoing THR [ 2 ] . Hematoma itself was found to be an independent risk factor for adverse outcomes, increasing morbidity and mortality, despite adequate treatment. We report a rare case of prosthetic dislocation following the embolization of a post-THR pseudoaneurysm. The dislocation was attributed to the mass effect produced by the temporary expansion of the pseudoaneurysm and its transformation into a hematoma. Following diagnosis, the patient underwent immediate surgical intervention and was subsequently discharged in stable condition. Case Presentation An 83-year-old woman with no significant past medical history underwent an uncomplicated right THR. Two weeks postoperatively, she presented to the outpatient clinic with right leg swelling and an elevated D-dimer level; consequently, aspirin was added to her regimen. Two weeks later, she presented to the emergency department with progressive swelling and pain in the right thigh, muscle cramps, anemia (Hgb 8.4 g/dL), and thrombocytopenia (platelet count 98 × 10³/µL). Computed tomography (CT) revealed acute bleeding and a pseudoaneurysm in the right medial thigh. Subsequent angiography identified the pseudoaneurysm originating from the right medial femoral circumflex artery (Fig. 1 a-c). Transarterial embolization (TAE) was performed using coils until near-total obliteration of the feeding artery and the pseudoaneurysmal sac was achieved (Fig. 1 d). Additionally, Gelfoam was utilized to reduce flow in the profunda femoris artery (PFA). Pain and muscle cramps were alleviated immediately following the embolization. One day following TAE, the patient returned to the emergency department with right thigh fullness and ecchymosis. Radiography revealed a partial dislocation of the right hip (Fig. 2 a), suggesting progressive hemorrhage. Repeat angiography, however, confirmed complete occlusion of the feeding artery with no further opacification of the pseudoaneurysm (Fig. 2 b). A non-contrast pelvic CT scan demonstrated that the hip dislocation was secondary to the mass effect of the pseudoaneurysm (Fig. 2 c). Comparisons of pre- and post-TAE CT scans showed the pseudoaneurysm had transformed from fluid to hematoma density, with an overall increase in size (Fig. 2 d, e). Consequently, the patient underwent open reduction and surgical evacuation of the hematoma. The intervention was well-tolerated, with no post-operative complications such as recurrent dislocation or persistent leg swelling. The patient was subsequently discharged in stable condition. Discussion and conclusions Pseudoaneurysms of the profunda femoris artery (PFA) are uncommon, usually caused by a traumatic or iatrogenic injury. Symptoms typically manifest by pain of sudden onset and swelling in the upper thigh [ 3 ] . The PFA is located deep within the thigh and is protected from external trauma by the vastus medialis muscle; however, it is most susceptible to injury in the subtrochanteric region [ 4 ] . Several techniques can be used for the diagnosis of pseudoaneurysms, including Doppler ultrasound (US), CT, magnetic resonance imaging (MRI), and angiography. Angiography is the best method for detecting vascular pathologies in cases with bleeding, giving valuable information on the site and size of the pseudoaneurysm, the feeding vessels, and patency and adequacy of distal flow [ 5 ] . We propose two possible mechanisms for the post-THR dislocation. First, the pseudoaneurysm underwent a transition from fluid blood to a consolidated hematoma following TAE. This is supported by our CT findings, which demonstrated a change from fluid density to hematoma density. We hypothesize that the organized hematoma, being more rigid than liquid blood, exerted a more significant mass effect on the surrounding structures. Second, an interval increase in the size of the pseudoaneurysm was observed after TAE. Immediate post-procedural angiography showed faint residual opacification of the feeding artery and the sac, whereas complete occlusion was only confirmed on follow-up angiography one day later. This period of incomplete embolization may have created a 'check-valve' phenomenon, allowing continued extravasation of blood without a corresponding outflow. This progression likely explains the shift in the patient’s clinical presentation from acute pain and muscle cramps to a sensation of fullness and subsequent joint instability. For all pseudoaneurysms, current therapeutic approaches include open surgical repair, US-guided compression, US-guided thrombin injection and endovascular repair using coil embolization or stent-graft insertion. The incidence of post-operative complications may be as high as 20%, with up to a 3% mortality rate [ 6 ] . Coils or microcoils are the preferred and most widely used agents for embolization of a pseudoaneurysm. The main aim of coil embolization is occlusion of the pseudoaneurysm and its neck, or its exclusion from circulation [ 7 ] . Recurrence of the pseudoaneurysm may occur secondary to incomplete exclusion or collateral supply, and rarely due to migration of coils. This would need repeat embolization. Waldherr et al. described the use of transluminal coil embolization to treat pseudoaneurysms of the deep femoral artery branch in one patient after hip replacement [ 8 ] . A primary strength of this case report is the detailed longitudinal documentation of a previously undescribed complication. The use of serial CT and angiographic imaging provided objective evidence for the 'check-valve' phenomenon and the subsequent transformation of the pseudoaneurysm into a consolidated hematoma. However, this study has certain limitations. As a single case report, these findings cannot be used to establish a definitive incidence rate of dislocation following embolization in THR patients. Additionally, while the clinical and imaging data strongly support our hypothesis, the exact timing of the dislocation in relation to the density change of the hematoma remains an estimation based on the patient's return to the emergency department. In conclusion, following TAE, a pseudoaneurysm may gradually transition from liquid blood into a consolidated hematoma. Temporary or incomplete embolization can induce a 'check-valve' phenomenon, leading to a transient enlargement of the pseudoaneurysmal sac. To the best of our knowledge, this represents the first reported case of THR dislocation caused by the mass effect of a pseudoaneurysm following TAE. Clinicians should be aware of the potential for short-term volume progression and the subsequent transformation into a rigid hematoma after embolization. Recognizing these phenomena is essential for the early diagnosis of prosthetic dislocation and for guiding timely surgical intervention to manage the resulting mass effect. Abbreviations THR: Total Hip Replacement TAE: Transarterial Embolization CT: Computed Tomography PFA: Profunda Femoris Artery US: Ultrasound MRI: Magnetic Resonance Imaging Declarations Clinical trial number Not applicable. Ethics approval and consent to participate This study has obtained Institutional Review Board (IRB) approval from Taipei Tzu Chi Hospital IRB committee (protocol code 14-IRB117 and date of approval August 18, 2025). Informed consent was obtained from the patient included in the study. Consent for publication Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request. Availability of data and materials No datasets were generated or analysed during the current study. Competing interests The authors declare no competing interests. Funding No funding was provided. Authors' contributions Dr. Hsu-Chao Chang contributed in data collection and writing the script. Dr. Chia-Hung Lu contributed in conceptualizing, manuscript proof reading and submission. All authors reviewed the manuscript. Acknowledgements Not applicable. Authors' information (optional) Taipei Tzu Chi Hospital, No. 289, Jianguo Rd., Xindian Dist., New Taipei City 231, Taiwan (R.O.C.). Hsu-Chao Chang, Chia-Hung Lu References Dargel J, Oppermann J, Brüggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int. 2014;111(51-52):884-90. Mortazavi SM, Hansen P, Zmistowski B, Kane PW, Restrepo C, Parvizi J. Hematoma following primary total hip arthroplasty: a grave complication. J Arthroplasty. 2013;28(3):498-503. Naouli H, Jiber H, Bouarhroum A. False aneurysm of perforating branch of the deep femoral artery-Report of two cases. Int J Surg Case Rep. 2015:14:36-9. Hanna GB, Holdsworth RJ, McCollum PT. Profunda femoris artery pseudoaneurysm following orthopaedic procedures. Injury. 1994; 25(7):477-9. Chong KC, Yap EC, Lam KS, Low BY. Profunda femoris artery pseudoaneurysm presenting with triad of thigh swelling, bleeding and anaemia. Ann Acad Med Singap. 2004; 33(2):267-9. Sedwitz MM, Hye RJ, Stabile BE. The changing epidemiology of pseudoaneurysm. Therapeutic implications. Arch Surg. 1988; 123(4):473-6. Madhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials. Korean J Radiol. 2016; 17(3):351-63. Waldherr C, Kickuth R, Ludwig K, Do DD, Triller J. Superselective embolization of deep femoral artery branch pseudoaneurysm with a coaxial microcatheter system. VASA. 2006;35(1):45-9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 23 Mar, 2026 Reviews received at journal 19 Feb, 2026 Reviewers agreed at journal 18 Feb, 2026 Reviewers agreed at journal 14 Feb, 2026 Reviews received at journal 14 Feb, 2026 Reviewers agreed at journal 14 Feb, 2026 Reviews received at journal 13 Feb, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviewers invited by journal 12 Feb, 2026 Editor assigned by journal 11 Jan, 2026 Editor invited by journal 26 Dec, 2025 Submission checks completed at journal 24 Dec, 2025 First submitted to journal 24 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8357281","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":591529104,"identity":"cc59a358-1ee6-4541-9eaf-acad04a07040","order_by":0,"name":"Hsu-Chao Chang","email":"","orcid":"","institution":"Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation","correspondingAuthor":false,"prefix":"","firstName":"Hsu-Chao","middleName":"","lastName":"Chang","suffix":""},{"id":591529105,"identity":"9a6aaa25-62dc-47af-a267-69d2d3ad0159","order_by":1,"name":"Chia-Hung Lu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIie2RvQrCMBRGEwLpcmnXlPrzCkpBcKnPUgSnboIgDlYK8Y2yS0A3Z6WL1SfooLTgYFo7Nx0Fc4bkI9xD8hGEDIYfxEYkrvYeRQjfVABbp1CEawWUQkZN6KhUmX1PdAoLd3nJA7AteVw/o0C9kGT3S7uSMJfPgcJikfaFCoj6ftSuxGzMCVAGk9QVKqg6nkZJipBvleK8lq7YdlI4O3BZ3UJxLmQHBTI+jc+nqovvYaEC0XRxrLm8FqvNYLiXWV6KzcyxkuzRptTg5i8I1KtuvObdqEWnaYPBYPg3PlBtOxmvtgDtAAAAAElFTkSuQmCC","orcid":"","institution":"Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation","correspondingAuthor":true,"prefix":"","firstName":"Chia-Hung","middleName":"","lastName":"Lu","suffix":""}],"badges":[],"createdAt":"2025-12-14 10:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8357281/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8357281/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102939900,"identity":"23585264-8ea5-4ae1-abd0-eb2d2bc49ba6","added_by":"auto","created_at":"2026-02-18 16:58:30","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":324824,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea \u003c/strong\u003eNon-contrast computed tomography (CT) scan, and \u003cstrong\u003eb\u003c/strong\u003e contrast-enhanced CT scan revealed acute bleeding and a pseudoaneurysm (short arrows) in the right medial thigh \u003cstrong\u003ec\u003c/strong\u003e Angiography revealed a pseudoaneurysm originating from the right medial femoral circumflex artery (long arrow) \u003cstrong\u003ed\u003c/strong\u003e Transarterial embolization (TAE) was performed using coils until nearly total obliteration of the feeding artery and the pseudoaneurysmal sac.\u003c/p\u003e","description":"","filename":"Fig.1abcd.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8357281/v1/52109514ff09e5e0306376a8.jpg"},{"id":102939899,"identity":"2aecfb8c-e336-4d26-9dfc-f287f437cff7","added_by":"auto","created_at":"2026-02-18 16:58:30","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":431611,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ea \u003c/strong\u003eRadiography taken one day after TAE showed a partial dislocation of the right hip \u003cstrong\u003eb\u003c/strong\u003e A repeat angiography showed complete occlusion of the feeding artery and no opacification of the pseudoaneurysm \u003cstrong\u003ec\u003c/strong\u003e Non-contrast pelvic CT scan showed a partial dislocation of the right hip due to mass effect of the pseudoaneurysm \u003cstrong\u003ed \u003c/strong\u003ePre-TAE\u003cstrong\u003e \u003c/strong\u003enon-contrast CT showed fluid density of the pseudoaneurysm with Hounsfield unit (HU) measuring 18.04 HU\u003cstrong\u003e e\u003c/strong\u003e Post-TAE\u003cstrong\u003e \u003c/strong\u003enon-contrast CT showed that the pseudoaneurysm has transformed into hematoma density, which was measured at 74.66 HU.\u003c/p\u003e","description":"","filename":"Fig.2abcde.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8357281/v1/16c938bc0c84f7fe16175691.jpg"},{"id":102939913,"identity":"3102c5d9-8890-40bf-b43d-394f23a9a937","added_by":"auto","created_at":"2026-02-18 16:58:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1143500,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8357281/v1/117af2bc-a332-4aa6-8708-1260ae357165.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Dislocation of Total Hip Replacement Prosthesis After Transarterial Embolization of A Pseudoaneurysm: Case Report","fulltext":[{"header":"Background","content":"\u003cp\u003eThe dislocation rate of primary hip replacements ranges from 0.2% to 10% per year, while that of artificial hip joints that have already been surgically revised can be as high as 28% \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. Hematoma following primary total hip replacement (THR) can require a return to the operating room. A hematoma that is large enough to require surgical attention is a complication that occurs in 0.41% of patients undergoing THR \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Hematoma itself was found to be an independent risk factor for adverse outcomes, increasing morbidity and mortality, despite adequate treatment. We report a rare case of prosthetic dislocation following the embolization of a post-THR pseudoaneurysm. The dislocation was attributed to the mass effect produced by the temporary expansion of the pseudoaneurysm and its transformation into a hematoma. Following diagnosis, the patient underwent immediate surgical intervention and was subsequently discharged in stable condition.\u003c/p\u003e"},{"header":"Case Presentation","content":"\u003cp\u003eAn 83-year-old woman with no significant past medical history underwent an uncomplicated right THR. Two weeks postoperatively, she presented to the outpatient clinic with right leg swelling and an elevated D-dimer level; consequently, aspirin was added to her regimen. Two weeks later, she presented to the emergency department with progressive swelling and pain in the right thigh, muscle cramps, anemia (Hgb 8.4 g/dL), and thrombocytopenia (platelet count 98 × 10³/µL). Computed tomography (CT) revealed acute bleeding and a pseudoaneurysm in the right medial thigh. Subsequent angiography identified the pseudoaneurysm originating from the right medial femoral circumflex artery (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ea-c). Transarterial embolization (TAE) was performed using coils until near-total obliteration of the feeding artery and the pseudoaneurysmal sac was achieved (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003ed). Additionally, Gelfoam was utilized to reduce flow in the profunda femoris artery (PFA). Pain and muscle cramps were alleviated immediately following the embolization.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eOne day following TAE, the patient returned to the emergency department with right thigh fullness and ecchymosis. Radiography revealed a partial dislocation of the right hip (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea), suggesting progressive hemorrhage. Repeat angiography, however, confirmed complete occlusion of the feeding artery with no further opacification of the pseudoaneurysm (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb). A non-contrast pelvic CT scan demonstrated that the hip dislocation was secondary to the mass effect of the pseudoaneurysm (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ec). Comparisons of pre- and post-TAE CT scans showed the pseudoaneurysm had transformed from fluid to hematoma density, with an overall increase in size (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ed, e). Consequently, the patient underwent open reduction and surgical evacuation of the hematoma. The intervention was well-tolerated, with no post-operative complications such as recurrent dislocation or persistent leg swelling. The patient was subsequently discharged in stable condition.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e "},{"header":"Discussion and conclusions","content":"\u003cp\u003ePseudoaneurysms of the profunda femoris artery (PFA) are uncommon, usually caused by a traumatic or iatrogenic injury. Symptoms typically manifest by pain of sudden onset and swelling in the upper thigh \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. The PFA is located deep within the thigh and is protected from external trauma by the vastus medialis muscle; however, it is most susceptible to injury in the subtrochanteric region \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Several techniques can be used for the diagnosis of pseudoaneurysms, including Doppler ultrasound (US), CT, magnetic resonance imaging (MRI), and angiography. Angiography is the best method for detecting vascular pathologies in cases with bleeding, giving valuable information on the site and size of the pseudoaneurysm, the feeding vessels, and patency and adequacy of distal flow \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWe propose two possible mechanisms for the post-THR dislocation. First, the pseudoaneurysm underwent a transition from fluid blood to a consolidated hematoma following TAE. This is supported by our CT findings, which demonstrated a change from fluid density to hematoma density. We hypothesize that the organized hematoma, being more rigid than liquid blood, exerted a more significant mass effect on the surrounding structures. Second, an interval increase in the size of the pseudoaneurysm was observed after TAE. Immediate post-procedural angiography showed faint residual opacification of the feeding artery and the sac, whereas complete occlusion was only confirmed on follow-up angiography one day later. This period of incomplete embolization may have created a 'check-valve' phenomenon, allowing continued extravasation of blood without a corresponding outflow. This progression likely explains the shift in the patient’s clinical presentation from acute pain and muscle cramps to a sensation of fullness and subsequent joint instability.\u003c/p\u003e\u003cp\u003eFor all pseudoaneurysms, current therapeutic approaches include open surgical repair, US-guided compression, US-guided thrombin injection and endovascular repair using coil embolization or stent-graft insertion. The incidence of post-operative complications may be as high as 20%, with up to a 3% mortality rate \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. Coils or microcoils are the preferred and most widely used agents for embolization of a pseudoaneurysm. The main aim of coil embolization is occlusion of the pseudoaneurysm and its neck, or its exclusion from circulation \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Recurrence of the pseudoaneurysm may occur secondary to incomplete exclusion or collateral supply, and rarely due to migration of coils. This would need repeat embolization. Waldherr et al. described the use of transluminal coil embolization to treat pseudoaneurysms of the deep femoral artery branch in one patient after hip replacement \u003csup\u003e[\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eA primary strength of this case report is the detailed longitudinal documentation of a previously undescribed complication. The use of serial CT and angiographic imaging provided objective evidence for the 'check-valve' phenomenon and the subsequent transformation of the pseudoaneurysm into a consolidated hematoma. However, this study has certain limitations. As a single case report, these findings cannot be used to establish a definitive incidence rate of dislocation following embolization in THR patients. Additionally, while the clinical and imaging data strongly support our hypothesis, the exact timing of the dislocation in relation to the density change of the hematoma remains an estimation based on the patient's return to the emergency department.\u003c/p\u003e\u003cp\u003eIn conclusion, following TAE, a pseudoaneurysm may gradually transition from liquid blood into a consolidated hematoma. Temporary or incomplete embolization can induce a 'check-valve' phenomenon, leading to a transient enlargement of the pseudoaneurysmal sac. To the best of our knowledge, this represents the first reported case of THR dislocation caused by the mass effect of a pseudoaneurysm following TAE. Clinicians should be aware of the potential for short-term volume progression and the subsequent transformation into a rigid hematoma after embolization. Recognizing these phenomena is essential for the early diagnosis of prosthetic dislocation and for guiding timely surgical intervention to manage the resulting mass effect.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eTHR:\u0026nbsp;\u003c/strong\u003eTotal Hip Replacement\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTAE:\u0026nbsp;\u003c/strong\u003eTransarterial Embolization\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCT:\u0026nbsp;\u003c/strong\u003eComputed Tomography\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePFA:\u003c/strong\u003e Profunda Femoris Artery\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUS:\u003c/strong\u003e Ultrasound\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMRI:\u0026nbsp;\u003c/strong\u003eMagnetic Resonance Imaging\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has obtained\u0026nbsp;Institutional Review Board (IRB) approval from Taipei Tzu Chi Hospital IRB committee (protocol code 14-IRB117 and date of approval August 18, 2025). Informed consent was obtained from the patient included in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was provided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDr. Hsu-Chao Chang contributed in data collection and writing the script. Dr. Chia-Hung Lu contributed in conceptualizing, manuscript proof reading and submission. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTaipei Tzu Chi Hospital, No. 289, Jianguo Rd., Xindian Dist., New Taipei City 231, Taiwan (R.O.C.).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eHsu-Chao Chang, Chia-Hung Lu\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eDargel J, Oppermann J, Br\u0026uuml;ggemann GP, Eysel P. Dislocation following total hip replacement. Dtsch Arztebl Int. 2014;111(51-52):884-90.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eMortazavi SM, Hansen P, Zmistowski B, Kane PW, Restrepo C, Parvizi J. Hematoma following primary total hip arthroplasty: a grave complication. J Arthroplasty. 2013;28(3):498-503.\u003c/li\u003e\n \u003cli\u003eNaouli H, Jiber H, Bouarhroum A. False aneurysm of perforating branch of the deep femoral artery-Report of two cases. Int J Surg Case Rep.\u0026nbsp;2015:14:36-9. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eHanna GB, Holdsworth RJ, McCollum PT. Profunda femoris artery pseudoaneurysm following orthopaedic procedures. Injury. 1994; 25(7):477-9.\u003c/li\u003e\n \u003cli\u003eChong KC, Yap EC, Lam KS, Low BY. Profunda femoris artery pseudoaneurysm presenting with triad of thigh swelling, bleeding and anaemia. Ann Acad Med Singap. 2004;\u0026nbsp;33(2):267-9.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSedwitz MM, Hye RJ, Stabile BE. The changing epidemiology of pseudoaneurysm. Therapeutic implications. Arch Surg. 1988; 123(4):473-6.\u003c/li\u003e\n \u003cli\u003eMadhusudhan KS, Venkatesh HA, Gamanagatti S, Garg P, Srivastava DN. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials. Korean J Radiol. 2016; 17(3):351-63.\u003c/li\u003e\n \u003cli\u003eWaldherr C, Kickuth R, Ludwig K, Do DD, Triller J. Superselective embolization of deep femoral artery branch pseudoaneurysm with a coaxial microcatheter system. VASA. 2006;35(1):45-9.\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Total hip replacement (THR), Dislocation, Pseudoaneurysm, Transarterial embolization (TAE), Case report","lastPublishedDoi":"10.21203/rs.3.rs-8357281/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8357281/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePseudoaneurysm is a rare complication after total hip replacement (THR). Prosthesis dislocation following embolization of a pseudoaneurysm is even more uncommon. We report a case of prosthesis dislocation after embolization of a pseudoaneurysm and discuss its possible underlying mechanisms.\u003c/p\u003e\u003ch2\u003eCase Presentation\u003c/h2\u003e \u003cp\u003eWe report the case of an 83-year-old woman who developed a right medial femoral circumflex artery pseudoaneurysm one month after THR, for which she underwent emergent transarterial embolization (TAE). One day after the procedure, she returned to the emergency department with a THR dislocation. Computed tomography (CT) imaging confirmed enlargement of the pseudoaneurysm and its transformation into a hematoma after TAE, resulting in increased mass effect and subsequent prosthesis dislocation. The patient underwent open reduction with evacuation of the blood clot and was discharged in stable condition.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eAwareness of the potential short-term progression of a pseudoaneurysm after TAE, and its subsequent transformation into a hematoma\u0026mdash;which may increase mass effect\u0026mdash;can facilitate early diagnosis when prosthesis dislocation is detected after embolization and guide appropriate management.\u003c/p\u003e","manuscriptTitle":"Dislocation of Total Hip Replacement Prosthesis After Transarterial Embolization of A Pseudoaneurysm: Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-18 16:58:24","doi":"10.21203/rs.3.rs-8357281/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-23T18:29:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-19T12:43:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"329034236291048206916696203037525417337","date":"2026-02-18T10:57:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1901042098862745599442342648163632341","date":"2026-02-15T04:29:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-14T22:58:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"15330203187948428727510701789124403985","date":"2026-02-14T22:42:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T23:29:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"307139339268755296986061026098272063468","date":"2026-02-13T23:20:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"275392132700274466421019254904025673869","date":"2026-02-13T22:49:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-12T15:22:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-11T13:37:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-26T10:00:43+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-25T01:52:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Musculoskeletal Disorders","date":"2025-12-25T01:48:42+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-musculoskeletal-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmsd","sideBox":"Learn more about [BMC Musculoskeletal Disorders](http://bmcmusculoskeletdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://author-welcome.nature.com/12891","title":"BMC Musculoskeletal Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ea9aa9cb-d6fb-4baa-84f7-148fcdd5f48d","owner":[],"postedDate":"February 18th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T06:24:37+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-18 16:58:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8357281","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8357281","identity":"rs-8357281","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}