Pujol Oriol, Mimendia Iñaki, Martin-Dominguez Lidia, Amat Carles, Barro Víctor
Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain; Hip Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron University Hospital, Barcelona, Spain.
Int J Surg Case Rep. 2021 Mar;80:105705. doi: 10.1016/j.ijscr.2021.105705. Epub 2021 Feb 25.
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.
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.
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.
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.
脱位是全髋关节置换术（THA）后的一种严重并发症。它是手术失败和翻修手术最常见的原因之一。这是首例有记录的双侧双动型（DM）全髋关节置换术同时发生脱位的病例。
一名49岁男性，出现双侧髋关节疼痛、活动受限及畸形。X线影像显示双侧全髋关节置换术后同时发生后脱位。该患者此前曾反复出现无创伤性脱位。当对其进行详细再次询问时，他诉说存在无法控制的全身性肌肉收缩，这与肝性脑病（HE）所致的肌阵挛相符。通过多学科治疗，令人满意地控制了肌阵挛症状并预防了脱位。
患者最重要的危险因素是神经肌肉疾病，我们最初对此关注不足且重视不够。肝性脑病是一种在肝功能不全患者中观察到的严重但可逆的综合征。它会导致广泛的神经精神异常。治疗基于预防发作，避免潜在诱因。鉴于我们的患者脱位风险高，我们决定双侧使用双动型髋臼杯。该系统已显示出较低的脱位率。
本病例报告提醒我们，面对反复出现的不稳定情况时，通过细致的病史询问和体格检查进行仔细评估是必不可少的。此外，预防脱位远比治疗这种具有挑战性的并发症要好得多。应识别高危患者，并综合运用合适的手术入路、技术和植入物，以制定减轻并理想地预防脱位的策略。
