A 55-year-old Caucasian man was admitted for a left-sided metal-on-metal primary hip arthroplasty for osteoarthritis. There was nothing significant in his medical history and he was a non-smoker with a body mass index (BMI) of 38. The patient experienced no significant intra-operative complications but required four units of blood immediately after his operation, which was attributed to intra-operative bleeding. On the first postoperative day, the patient's hemoglobin level was 65 gm/l. He was subsequently transfused with three units of blood. His low hemoglobin levels were again attributed to intra-operative bleeding. On the second postoperative day, the patient complained of intermittent pain in his left thigh that was associated with numbness and tingling in his toes. His thigh was swollen, but the incision site was dry and there was no pulsatile mass. He remained hemodynamically stable and had distal pulses. His hemoglobin was still only 70 gm/l despite him being transfused with seven units of blood. His clotting profile was also normal. It was thought that the patient had a hematoma which could be was responsible for the pain, the altered sensation, the swelling, and the drop in hemoglobin. The patient was transfused with two more units of blood and four units of fresh frozen plasma. On the third postoperative day, since the patient's hemoglobin remained low despite repeated transfusions, an emergency angiogram was performed. The angiogram revealed an injury that was distal to the left common femoral artery. The profunda femoral artery was noted to be normal. The vessel was not suitable for embolisation due to its close proximity to the common femoral artery bifurcation. The patient therefore underwent an open exploration of his left groin. An avulsion injury to a posterior perforating branch of the profunda femoral artery was identified and ligated. A left psoas hematoma and a hematoma in the deep tissue of the upper thigh were also drained. The patient recovered well after the second operation and was discharged 12 days after his initial surgery.