567 - Management of Post-Total Hip Arthroplasty Hematoma: A Case Report

Case Diagnosis: Post-Total Hip Arthroplasty Hematoma

Case Description: A 78-year-old male with mechanical aortic valve on warfarin was admitted for elective right total hip arthroplasty (THA). During inpatient rehabilitation, he developed acute worsening right hip pain at rest. Workup revealed a drop in hemoglobin from 11 to 6.6 g/dL prompting transfusion, and a gluteus maximus hematoma (6.3x5.2x13cm). Orthopedic surgery, interventional radiology, and hematology were consulted for consideration of drainage given concern for active bleed. The patient was admitted to acute care for warfarin reversal and supervision while anticoagulants were held. The rehabilitation team did not want to waste the patient’s available rehabilitation days while pending possible procedure. Ultimately, no surgical intervention was required, and hematology recommended resuming enoxaparin. After stabilization, patient returned to rehab and restarted warfarin. The patient is now actively participating in therapies with close monitoring of INR levels, ensuring optimal anticoagulation management during his recovery.

Discussions: This case highlights the importance of patient selection for inpatient rehabilitation. Postoperative hematoma is a common complication of THA, occurring up to 10% of patients. Inpatient rehabilitation allows for close monitoring and treatment of complications. Only 47% of patients over the age of 60 who undergo THA are admitted to inpatient rehabilitation despite a 50% six-month mortality rate in patients who suffer hip fractures. Had this patient not been admitted to inpatient rehab, the hematoma could have been missed leading to complications like acute pain, decrease in functional mobility, dizziness in the home, and emergent readmission. Additionally, this patient was at increased risk due to his age and comorbidities.

Conclusions: This case underscores the importance of inpatient rehabilitation after total hip arthroplasty, especially for patients who have comorbidities and are at increased risk of complications. We advocate for more patients who undergo hip surgeries to be admitted to inpatient rehabilitation, ensuring the best care possible.