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A fifty-nine year old gentleman underwent a right total hip replacement in another hospital for protrusio osteoarthritis of the right hip. Post-operatively he developed a large right-sided ilio-femoral deep venous thrombosis. A pelvic radiograph showed that the acetabular construct had migrated medially into the pelvis with a CT scan showing compression of the external iliac vessels by one of the acetabular screws. Revision surgery was carried out in collaboration with the vascular surgeons. This case report highlights the importance of pre-operative planning to avoid medial wall perforation in patients with protrusio osteoarthritis. It also illustrates an unusual complication of compression of the external iliac vessels causing massive ilio-femoral thrombosis. The management of this potentially limb threatening complication is described in this case report.

External iliac vein compression and thrombosis by a migrated acetabular screw following total hip arthroplasty