Simultaneous bilateral dual mobility total hip arthroplasty dislocation in a patient with hepatic encephalopathy: A case report

Luxació; Mobilitat dual; Encefalopatia hepàticaDislocación; Movilidad dual; Encefalopatía hepáticaDislocation; Dual mobility; Hepatic encephalopathyIntroduction 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

Cross-cultural adaptation for the Spanish population of the modified Harris score for functional and symptomatic hip joint assessment

Adaptación; Cadera; EscalaAdaptació; Maluc; EscalaAdaptation; Hip; ScaleAntecedente y objetivos La Escala de Harris modificada es una de las escalas más utilizadas para la valoración funcional de los pacientes en la patología de cadera. Sin embargo, no existe una adaptación transcultural para la sociedad española. Por tanto, este estudio se plantea obtener una adaptación transcultural para la población española de la escala de cadera de Harris modificada. Materiales y métodos Para la adaptación transcultural se utilizó el método de Beaton que incluye: 2 traducciones al idioma español; revisión por expertos de las 2 versiones provisionales y obtención de una única versión en español; traducción reversa (a inglés) de la versión en español; y aplicación de la versión adaptada. La versión adaptada fue aplicada en 2 ocasiones a 100 pacientes, con un periodo de separación de 6 meses. Resultados Entre la aplicación inicial y final de la versión adaptada no se encontró diferencias clínicamente relevantes. Conclusiones Se obtuvo una traducción y adaptación transcultural para la población española de la escala de cadera de Harris modificada, la misma que debería ser aplicada a la población española y a todos los países hispanohablantes, mientras no cuenten con una versión adaptada para la población a la que pertenecen.Background and objectives The modified Harris hip score, is one of the most widely used scales for the functional assessment of hip pathology of the patients. However, there is no cross-cultural adaptation for the Spanish society. Therefore, this study aims to obtain a cross-cultural adaptation of the modified Harris hip score for the Spanish population. Materials and methods For the cross-cultural adaptation the Beaton method was used, which includes: 2 translations into Spanish; expert review of the 2 provisional versions and obtaining a single Spanish version; reverse translation (into English) of the Spanish version; and application of the adapted version. The adapted version was applied twice to 100 patients, 6 months apart. Results Between the initial and final application of the adapted version, no clinically relevant differences were found. Conclusions A cross-cultural translation and adaptation of the modified Harris hip score for the Spanish population was obtained, which should be applied to the Spanish population and to all Spanish-speaking countries, as long as they do not have an adapted version for the population to which they belong