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Mimendia I, Barro V, Sierra M, Aliaga-Martínez A, Guerra-Farfán E, Hernández A. Fused hip conversion to total hip arthroplasty with the direct anterior approach: surgical technique on a regular surgical table under fluoroscopic guidance. Int Orthop 2024; 48:1165-1170. [PMID: 38438578 DOI: 10.1007/s00264-024-06131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE Conversion of a fused hip to a total hip arthroplasty (THA) is technically challenging due to the loss of anatomical references. Here, a reproducible technique using the direct anterior approach (DAA) with a regular surgical table under fluoroscopic guidance is described, which has several advantages over traditional such as lateral or posterior approaches. METHODS There were reported 11 cases of ankylosis hip that were converted to THA using the same surgical technique protocol. Clinical and radiographic outcomes were recorded at 3.2 years of follow-up. A detailed preoperative evaluation was performed, including a pelvis radiological evaluation and magnetic resonance image (MRI) to assess the integrity of the periarticular soft tissue and flexor muscles. RESULTS The DAA has considerable advantages, such as allowing more precise targeting during surgery, avoiding the risk of pseudoarthrosis due to the absence of a trochanteric osteotomy, preserving the abductors, and allowing an easier-to-use of intraoperative fluoroscopy due to the supine position. Besides, the use of a standard table reduces surgical time and allows assessment of limb length, hip stability, and impingement in all planes in an intraoperative dynamic range, which decreases postoperative complications. CONCLUSION Conversion from hip fusion to THA is a rare and complex procedure. The use of DAA with a standard table and fluoroscopy helps to avoid high complications since it allows a dynamic intra-operative examination of the range of motion to rule out impingements, reduces the risk of dislocation, and allows leg lengthening verification.
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Affiliation(s)
- Iñaki Mimendia
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Víctor Barro
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Martin Sierra
- Instituto Nacional de Ortopedia y Traumatología, Universidad de La República, Montevideo, Uruguay
| | - Andrés Aliaga-Martínez
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Ernesto Guerra-Farfán
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandro Hernández
- Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
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Lara-Taranchenko Y, Nomdedéu JF, Barro VM, Peiró JVA, Guerra-Farfán E, Selga J, Tomás-Hernández J, Teixidor Serra J, Molero V, Collado D, Mimendia I, Hernández A, Porcel-Vázquez JA. Vancouver B2 periprosthetic hip fractures treatment: fix or replace? A retrospective study comparing both techniques. Eur J Orthop Surg Traumatol 2024:10.1007/s00590-024-03881-2. [PMID: 38528273 DOI: 10.1007/s00590-024-03881-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/18/2024] [Indexed: 03/27/2024]
Abstract
INTRODUCTION Vancouver B2 periprosthetic hip fractures involve stem stability and they have been classically treated with revision surgery. Crucial factors such as age, clinical comorbidities and functional status are often neglected. The current study aims to compare clinical outcomes between patients treated with open reduction and internal fixation (ORIF) or femoral stem exchange. METHODS This is a retrospective study that includes all Vancouver B2 periprosthetic hip fractures in a tertiary referral hospital from 2016 to 2020. Patients were divided into two groups: Group 1. Patients treated with an ORIF and Group 2. Patients treated with stem replacement. The outcomes that were compared between groups included demographic data, functional capacity, complications and mortality. RESULTS 29 periprosthetic Vancouver B2 fractures were finally analyzed. 11 (37.9%) were treated with ORIF (Group 1) and 18 (62.1%) by stem replacement (Group 2). Surgery time (143 vs. 160 min), hemoglobin drop (1.8 vs. 2.5 g/dL) and hospital stance (25.5 vs. 29.6 days) were shorter in Group 1. According to complications, 18.2% of patients in the ORIF group had orthopedic complications compared with 44.4% in the revision group. In the revision group, 3 cases needed a two-stage revision and one of these revisions ended up with a resection arthroplasty (Girdlestone). The first-year mortality rate was 27% in Group 1 and 11% in Group 2. DISCUSSION ORIF treatment seems to be a less aggressive and complex procedure which can lead to a faster general recovery. Revision surgery can imply a higher risk of orthopedic complications which can be severe and may require further aggressive solutions. The ORIF group mortality was similar to the proximal femur fracture rate (20-30%). In conclusion, ORIF treatment seems to be a good option especially in fragile patients with low functional demand when anatomical reduction is possible.
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Affiliation(s)
- Yuri Lara-Taranchenko
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Josep F Nomdedéu
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Víctor M Barro
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - José V Andrés Peiró
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Ernesto Guerra-Farfán
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Selga
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Tomás-Hernández
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jordi Teixidor Serra
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Vicente Molero
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Diego Collado
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Iñaki Mimendia
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Alejandro Hernández
- Orthopedic Surgery Resident, Hospital Universitari Vall d'Hebron, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Juan A Porcel-Vázquez
- Hospital Universitari Son Espases, Illes Balears, Carretera de Valldemossa, 79, 07120, Palma, Spain
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Mimendia I, Lakhani K, Núñez JH, Barro V, Guerra-Farfán E, Collado D, Hernández A. Total hip arthroplasty associated with transverse subtrochanteric shortening osteotomy and conical stem fixation in Crowe type IV hip dysplasia. Musculoskelet Surg 2023; 107:367-372. [PMID: 36869994 DOI: 10.1007/s12306-023-00779-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) in high-dislocated hip dysplasia is a surgical challenge, presenting difficulties in the biomechanical reconstruction of the hip. The purpose of the present study is to analyze clinical and radiological outcomes of a series of patients with Crowe type IV hip dysplasia who underwent a THA with transverse subtrochanteric shortening osteotomy and conical stem fixation in our Hip surgery unit. METHODS This non-interventional retrospective study included all patients diagnosed with Crowe type IV hip dysplasia who underwent a THA using a subtrochanteric shortening osteotomy and uncemented conical stem fixation between January 1, 2008, and December 31, 2015. Demographic, clinical and radiologic data were analyzed, including Harris Hip Score and Oxford Hip Score. RESULTS Seventeen hips in 13 patients were included in the final analysis. All patients were women and mean age was 39 years (range 35-45). Mean follow-up was 5.6 years (range 1-8). Average length of the osteotomy was 3.4 cm (range 3-4.5) and mean lowering of the center of rotation was 5.67 cm (range 3.8-9.1). Mean time for bone union was 5.5 months. No nerve palsy or non-union was detected at the end of follow-up period. CONCLUSION The use of cementless conical stem fixation associated with a transverse subtrochanteric shortening osteotomy for treating Crowe type IV hip dysplasia permits to correct the rotational alterations of the femur and provides good stability of the osteotomy, with very low risk of nerve palsy and non-union rates.
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Affiliation(s)
- I Mimendia
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - K Lakhani
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Traumatology and Rehabilitation, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebrón, 119., 08035, Barcelona, Spain.
| | - J H Núñez
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - V Barro
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - E Guerra-Farfán
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - D Collado
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Hernández
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Pujol O, Carrasco MG, Vicente M, Mimendia I, García Y, Selga J, Barro V. Should we employ preoperative templating in hip hemiarthroplasty after femoral neck fracture? A nested case-control study. Hip Int 2022; 32:537-542. [PMID: 33074739 DOI: 10.1177/1120700020964776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Dislocation following hip hemiarthroplasty is a serious complication. It remains unclear if acetabular morphology is associated with a higher risk of dislocation. The aim of our study was to investigate whether there are differences in hip morphology radiological parameters between patients who have suffered a dislocation episode, and those who have not suffered a dislocation. MATERIAL AND METHODS Between January 2015 and December 2018, a nested case-control study was performed. From 707 patients who underwent hip hemiarthroplasty because of femoral neck fracture, 50 patients (50 hips) suffered an episode of dislocation. They were randomly matched with 94 patients (100 hips) without dislocation (ratio 1:2). Clinical data regarding demographics, medical comorbidities and surgical and radiological parameters were studied. RESULTS Statistically significantly smaller lateral centre-edge angle (LCEA) and femoral offset (FO) and greater Tönnis angle were found in the dislocation group. No differences in acetabular angle were seen. Neurological impairment prevalence was statistically significantly higher in patients who suffered a dislocation (60% vs. 44%, p = 0.011). CONCLUSIONS The current study suggests that a smaller LCEA and FO, a greater TA, and neurological impairment could be related to a higher risk of hip hemiarthroplasty dislocation after femoral neck fracture in the elderly. We consider that preoperative templating could be helpful in identifying abnormal parameters and carefully planning surgery could lead to changes in treatment strategy, such as choosing a dual-mobility total hip arthroplasty.
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Affiliation(s)
- Oriol Pujol
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - María G Carrasco
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Matías Vicente
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain
| | - Iñaki Mimendia
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain
| | - Yaiza García
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Vall d'Hebron Institute of Research (VHIR), Vall d'Hebron University, Barcelona, Spain
| | - Jordi Selga
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Trauma Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain
| | - Víctor Barro
- Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain.,Hip Surgery Unit, Orthopaedic Surgery Department, Vall d'Hebron University, Barcelona, Spain
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Lakhani K, Mimendia I, Porcel JA, Martín-Domínguez LA, Guerra-Farfán E, Barro V. Direct anterior approach provides better functional outcomes when compared to direct lateral approach in hip hemiarthroplasty following femoral neck fracture. Eur J Orthop Surg Traumatol 2022; 32:137-143. [PMID: 33760998 DOI: 10.1007/s00590-021-02941-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/16/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aims to compare the differences between direct anterior approach (DAA) and direct lateral approach (DLA) in hip hemiarthroplasty (HHA) after displaced femoral neck fracture (FNF) in early functional outcome, hospital length of stay, morbidity and mortality rates. METHODS This non-interventional retrospective study, carried out at a tertiary trauma centre within the Spanish National Health System, included all patients who underwent a bipolar HHA between 1st January 2018 and 31st December 2019 performed by 2 of our hip unit surgeons. RESULTS A total of 94 patients were included (40 in DAA group and 54 in DLA group). Median follow-up was 19.2 months (range 8-30.8 months). Postoperative degree of mobilisation showed statistically significant differences in favour of DAA group, where 35% of patients were able to walk with no assistance after surgery. DAA group had 1 day less of hospitalisation in contrast with DLA group overall (8 days vs 9 days, respectively, p < 0.05). Statistically significant differences were not detected in comparing postoperative complications, re-operations rates or 6-months mortality rate. CONCLUSION Our study highlights the benefits of DAA for HHA after displaced FNF in terms of postoperative mobilisation degree and hospitalisation length of stay when compared to DLA.
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Affiliation(s)
- Kushal Lakhani
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Iñaki Mimendia
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Juan Antonio Porcel
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Lidia A Martín-Domínguez
- Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Dexeus, Barcelona, Spain
| | - Ernesto Guerra-Farfán
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Víctor Barro
- Department of Traumatology and Orthopedic Surgery, Hospital Universitari Valld'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Department of Traumatology and Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Hernández A, Lakhani K, Núñez JH, Mimendia I, Pons A, Barro V. Can we trust combined anteversion and Lewinnek safe zone to avoid hip prosthesis dislocation? J Clin Orthop Trauma 2021; 21:101562. [PMID: 34434695 PMCID: PMC8365454 DOI: 10.1016/j.jcot.2021.101562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/06/2020] [Accepted: 08/05/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Dislocation is one of the most common complications after primary total hip arthroplasty (THA). Combined anteversion (CA) is currently considered one of the most important measures of stability for THA. Thus, the aim of this study is to determine the association between a correct CA after THA and hip prosthesis dislocation, and to analyze the reliability of the Lewinnek safe zone parameters. MATERIAL AND METHODS This is a non-interventional retrospective study, carried out at a tertiary hospital in Spain. 2489 primary THA in 2147 patients between January 2008 and December 2014 were identified. Clinical, biological and radiographic data, including cup inclination and cup and femoral anteversion, were analyzed of all patients who developed a hip prosthesis dislocation. RESULTS Thirty-four patients met the eligibility criteria to be analyzed. In 73.5% (25/34) of cases, acetabular anteversion (AV) was correct, with a mean AV of 15.1° ± 9.4°. Femoral anteversion (FA) was considered correct only in 38.2% (13/34) of the dislocated THA, with a mean FA of 8.4° ± 17.2°. Sixteen of these 34 patients (47.0%) presented a correct CA, with a mean CA of 24.2° ± 21.0°. Nineteen hips (55.8%) were within the Lewinnek safe zone. Moreover, eleven patients (32.3%) developed a dislocation even though components were within the Lewinnek safe zone and presented a correct CA. CONCLUSION Our findings suggest that even when the THA components are positioned within a correct CA and in the Lewinnek safe zone, hip prosthesis dislocations can occur in a not inconsiderable percentage of the cases. Thus, further radiological and clinical analysis should be done to identify potential reasons for hip prosthesis dislocation.
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Affiliation(s)
- Alejandro Hernández
- Hip Unit, Department of Orthopedic Surgery, University Hospital of Vall d’Hebron, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain,Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Kushal Lakhani
- Hip Unit, Department of Orthopedic Surgery, University Hospital of Vall d’Hebron, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain,Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Jorge H. Núñez
- Hip Unit, Department of Orthopedic Surgery, University Hospital of Vall d’Hebron, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain,Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain,Corresponding author. Hip Unit, Department of Orthopedic Surgery, University Hospital of Vall d’Hebron. Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119, Barcelona, Spain.
| | - Iñaki Mimendia
- Hip Unit, Department of Orthopedic Surgery, University Hospital of Vall d’Hebron, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain,Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Aleix Pons
- Hip Unit, Department of Orthopedic Surgery, University Hospital of Vall d’Hebron, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain,Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Víctor Barro
- Hip Unit, Department of Orthopedic Surgery, University Hospital of Vall d’Hebron, Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain,Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
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Pujol O, Mimendia I, Martin-Dominguez L, Amat C, Barro V. Simultaneous bilateral dual mobility total hip arthroplasty dislocation in a patient with hepatic encephalopathy: A case report. Int J Surg Case Rep 2021; 80:105705. [PMID: 33662911 PMCID: PMC7937745 DOI: 10.1016/j.ijscr.2021.105705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Dislocation is a severe complication after total hip arthroplasty (THA). It is one of the most common reasons for failure and revision surgery. This is the first case of a documented simultaneous bilateral dual mobility (DM) THA dislocation. CASE PRESENTATION A forty-nine-year-old man presented with bilateral hip pain, immobility and deformity. X-ray images demonstrated simultaneous bilateral posterior THA dislocation. Previously, the patient had presented atraumatic dislocations recurrently. When he was thoroughly re-interrogated, he complained of uncontrolled and generalized muscle contractions, which were compatible with myoclonus due to hepatic encephalopathy (HE). Multidisciplinary treatment was performed satisfactorily to control myoclonus symptomatology and to prevent dislocation. CLINICAL DISCUSSION Patient's most important risk factor was a neuromuscular disorder, which we initially gave little notice and undervalued. HE is a serious but reversible syndrome, observed in patients with liver dysfunction. It leads to a wide spectrum of neuropsychiatric abnormalities. Management is based on prevention of episodes, avoiding the underlying triggers. Due to the high risk for dislocation of our patient, we decided to use DM cups bilaterally. This system has demonstrated lower rates of dislocation. CONCLUSION This case report reminds us that a careful evaluation through meticulous history and physical examination are mandatory when faced with recurrent instability. Furthermore, prevention of dislocation is vastly preferable to treating this challenging complication. High-risk patients should be identified, and appropriate surgical approach, technique and implants have to be collectively used to reach a strategy that mitigates and ideally prevents dislocation.
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Affiliation(s)
- Oriol Pujol
- Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
| | - Iñaki Mimendia
- Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Carles Amat
- Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Septic and Reconstructive Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Víctor Barro
- Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain
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