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

## TL;DR

This paper discusses the challenges and complications faced during bilateral hip replacement surgery in patients with inflammatory arthritis, emphasizing the need for surgeons to anticipate unusual anatomical conditions.

## Contribution

The paper highlights specific intraoperative complications and technical features encountered in a rare series of five cases with inflammatory coxarthritis.

## Key findings

- Abnormal bone fragility was observed in 55% of the cases, leading to intraoperative complications.
- An unusual sciatic nerve position was found in a case with ankylosed hips due to retracted gluteal structures.
- One case of cement shock occurred immediately after cement placement during surgery.

## Abstract

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.