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oai:recercat.cat:11351/72882025-10-24T10:26:31Zcom_2072_378070com_2072_378040col_2072_378092

2025-10-24T10:26:31Z urn:hdl:11351/7288 Simultaneous bilateral dual mobility total hip arthroplasty dislocation in a patient with hepatic encephalopathy: A case report Pujol Alarcón, Oriol Mimendia Sancho, Iñaki Martin-Dominguez, Lidia Amat Mateu, Carles Barro Ojeda, Victor Encefalopatia hepàtica Artroplàstia total de maluc - Complicacions Articulació coxofemoral - Luxació ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Orthopedic Procedures::Arthroplasty::Arthroplasty, Replacement::Arthroplasty, Replacement, Hip Other subheadings::Other subheadings::Other subheadings::/adverse effects DISEASES::Wounds and Injuries::Joint Dislocations::Wounds and Injuries::Hip Dislocation DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Brain Diseases, Metabolic::Hepatic Encephalopathy TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos ortopédicos::artroplastia::artroplastia de sustitución::artroplastia de sustitución de cadera Otros calificadores::Otros calificadores::Otros calificadores::/efectos adversos ENFERMEDADES::heridas y lesiones::luxaciones articulares::heridas y lesiones::luxación de la cadera ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::enfermedades cerebrales metabólicas::encefalopatía hepática Luxació; Mobilitat dual; Encefalopatia hepàtica Dislocación; Movilidad dual; Encefalopatía hepática Dislocation; Dual mobility; Hepatic encephalopathy 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. 2025-10-24T10:26:31Z 2025-10-24T10:26:31Z 2022-03-31T10:49:29Z 2022-03-31T10:49:29Z 2021-03 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://hdl.handle.net/11351/7288 International Journal of Surgery Case Reports;80 https://doi.org/10.1016/j.ijscr.2021.105705 Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess Elsevier Scientia