Mid-term results of bilateral synchronous total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis

Case Report: 3D printing of customized combined guides assisting total hip arthroplasty for treatment of fused hip: a case report

Background

Converting a fused hip to total hip arthroplasty (THA) presents considerable surgical challenges. Traditional surgical techniques frequently result in malalignment of osteotomy planes and inaccurate prosthetic placement, leading to a high incidence of perioperative complications.

Case summary

This report describes a 64-year-old male patient who underwent debridement surgery for right tuberculous hip arthritis 52 years ago. Following the operation, the joint gradually fused spontaneously, causing limited mobility. Over the past 4 years, the patient has experienced right knee pain and an unstable gait. The pathological fusion of the hip joint posed great challenges for THA, particularly in determining the osteotomy plane, ensuring adequate bone support, and reconstructing the acetabular rotation center. Using CT data, we designed and 3D printed a customized acetabular prosthesis with a series of combined guide systems, which allowed precise osteotomy and prosthetic implantation during the surgery. However, the patient developed a Mycobacterium avium infection following the procedure. As a result, debridement surgery, replacement of the acetabular liner, and combined pharmacological treatment were completed. Ultimately, the infection was controlled. A 5.5-year follow-up exhibited an improvement in the Harris hip score from 41 preoperatively to 90 postoperatively. The patient's ability to perform activities of daily living improved significantly, and radiological follow-up indicated good prosthetic positioning without signs of loosening or displacement.

Conclusion

The use of 3D-printed customized combined guides in THA offers a precise and safe treatment option for patients with hip joint fusion, effectively overcoming surgical challenges associated with altered anatomy. Moreover, this approach provides a reliable treatment reference for similar complex cases. The occurrence of M. avium infection in this patient underscores the importance of perioperative infection control and prompt management in patients with a history of tuberculosis.

Dual-mobility with modular components for primary total hip arthroplasty in bilateral bony ankylosis of the hips: A case report

INTRODUCTION AND IMPORTANCE

Primary total hip arthroplasty (THA) is a procedure performed in the United States for a variety of indications, with operation rates slated to increase over 275 % by 2040 when compared to 2014 (Thilak et al., 2015). Dual-mobility (DM) implants have gained popularity in the United States since gaining approval in the early 2010s (Heckmann et al., 2020). It has been well reported that DM implants decrease the risk of dislocation after primary and revision THA (Vielpeau et al., 2011; Donovan et al., 2022; Heifner et al., 2023; Foissey et al., 2023; Schmidt et al., 2020; Neri et al., 2019).

CASE PRESENTATION

We present the case of a 33-year-old male with a suspected ankylosing spondylitis (AS) diagnosis and bilateral bony ankylosis of the hips who underwent staged THA with modular dual-mobility (MDM) implants. At one year post-operatively, the patient is walking without the use of an assistive device and reports a VAS pain score of 0 at rest and 2 with activity and HHS of 90.

CLINICAL DISCUSSION

Implant selection is important in this patient population due to the increased risk of dislocation. Contemporary reports reveal MDM implants have demonstrated a substantial reduction in dislocation risk compared to fixed-bearing implants in patients with a high risk of dislocation. We opted to place the acetabular component inside the safe zone to improve stability and use the dual-mobility prosthesis to achieve our desired range of motion.

CONCLUSION

The improved stability of DM implants allows for a greater range of acetabular positions in patients who have a highly unpredictable functional outcome at the time of surgery. Our preliminary results contribute to the growing list of indications for MDM total hip arthroplasty.

Bilateral Total Hip Prosthesis in Coxarthritis of Inflammatory Origin: Technical Features and Intraoperative Complications Encountered in Five Cases

Total hip arthroplasty remains the treatment of last resort in inflammatory coxarthritis, where joint destruction is bilateral as well as the treatment which must be bilateral. We present in this work the experience of our orthopaedic department with a series of five cases (10 hips) operated for total hip arthroplasty. the first particularity observed in this series is the abnormal bone fragility present in 55% of the cases. For this reason, we had two other intraoperative complications that are related to this bone fragility, during the preparation of the acetabulum, we had a destruction of the medial wall by the burr that went unnoticed intraoperatively and was discovered during the patient's recovery from acute ischemia secondary to the burr, which led to an extensive rupture of the common femoral vein and partial sectioning of the common femoral artery. We also had an exceptional incident in a case with two ankylosed hips; in fact, when the approach was performed, the sciatic nerve was found pressed against the posterior surface of the greater trochanter, which was unusual but was explained by the retraction of the structures of the gluteal region secondary to prolonged immobilization. Thus, there was one case of cement shock manifested by hypotension occurring immediately after cement placement. In front of this inflammatory disease and ankylosis terrain, the surgeon must always be prepared for any complication and must keep in mind that he is operating on a hip that is anatomically not normal due to ankylosis and retraction of the vascular, nerve, and muscle structures.

Single-stage bilateral conversion arthroplasty for hip fusion via direct anterior approach in a patient with severe ankylosing spondylitis and kyphoscoliosis: a case report

BACKGROUND

Severe ankylosing spondylitis (AS) frequently involves hip joints and, occasionally, presents with concurrent spinal deformities, such as kyphoscoliosis, creating complex challenges for surgical management.

CASE PRESENTATION

We present a 26-year-old Persian male with a history of AS and severe kyphoscoliosis, leading to bilateral hip fusion and immobility. Following spinal deformity correction, a one-stage bilateral conversion to total hip arthroplasty (THA) was conducted through the direct anterior approach.

CONCLUSION

Primary correction of spinal deformities allows for extended surgical procedures under general anesthesia. Single stage bilateral hip conversion arthroplasty via the direct anterior approach enhances postoperative mobilization, reduce the risk of re-ankylosis, and improve the overall quality of life for AS patients with this unique presentation.