Abstract
Background Direct anterior approach(DAA) for total hip arthroplasty (THA), which has the characteristics of less trauma, quick recovery and low risk of early dislocation, is a popular surgical procedure for osteonecrosis of the femoral head. Common early complications of DAA total hip arthroplasty include the injury of lateral femoral cutaneous nerve, deep vein thrombosis, poor incision healing and unequal length of legs, etc. Emphysema of scrotum and thigh is very rare and there is no report about it occurred after DAA total hip arthroplasty.Case presentation: This is the first report about emphysema of scrotum and thigh after DAA total hip arthroplasty. A 55-year-old man with osteonecrosis of the left femoral head suffered unexplained emphysema of scrotum and the left thigh after DAA total hip arthroplasty. On the second day after operation, the patient complained of swelling and pain in his left thigh and swelling in the scrotum. The ultrasound examination of the scrotum indicated subcutaneous emphysema of the scrotum. The computed tomography scan and the ultrasound examination of the left thigh revealed pneumoderm and air in the intramuscular spaces. we gave the patient symptomatic treatment to ease pain and improve blood circulation, but we did not obtain a obvious curative effect. On the ninth postoperative day, the swelling of the patient’s left thigh and the scrotum partially relieved and he was discharged. The patient recovered well at one month and one year follow-up.Conclusion We firstly report a rare complication of emphysema of scrotum and thigh after direct anterior approach total hip arthroplasty in order to recommend it to orthopedists and attach their attention. We did not find the exact cause of this rare complication and hope to discuss the potential causes with all colleagues at the same time.