Successful Treatment of Total Hip Arthroplasty to a Patient Associated with Alcoholic Cirrhosis and Severe Plated Deficiency with Preoperative Partial Splenic Embolization

Abstract

Introduction: We present the first report of the successful treatment of Total Hip Arthroplasty (THA) to a patient associated with alcoholic cirrhosis and plated deficiency undergoing preoperative Partial Splenic Embolization. Case Report: A 45-year woman who had Liver Cirrhosis (LC) and alcohol residue heritage failure suffered from severe groin pain and had a difficulty in walking for a long period due to avascular necrosis of bilateral femoral head. She was referred to our orthopaedic service and THA was planned. Despite preoperative transfusion for her platelet deficiency coursed by LC, preoperative platelet count decreased less than a normal range. Therefore, Partial Splenic Embolization (PSE) was applied to her so as to increase platelet count. PSE could temporally reduce the portal vein pressure and prevent a hyperspleism and cytopenia. After the procedure, THA was performed to bilateral hip safely through a direct anterior approach. At the time of the latest follow-up, the patient had an excellent clinical result. Conclusion: Preoperative PSE may be a useful procedure to the patients with LC and severe plated deficiency who need arthroplasty including THA. Pre-existing physical and psychological factors have an effect on the outcome of arthroplasty and appropriate strategies might be needed.