Spinopelvic Instability in Conversion Total Hip Arthroplasty: A Complicated Case of Loeys-Dietz Syndrome

Jorge De Leon; Farhan Ahmad; Kavina Patel; Frank Buttacavoli

doi:10.1016/j.artd.2020.09.019

Spinopelvic Instability in Conversion Total Hip Arthroplasty: A Complicated Case of Loeys-Dietz Syndrome

Arthroplast Today. 2020 Nov 20;6(4):1009-1015. doi: 10.1016/j.artd.2020.09.019. eCollection 2020 Dec.

Authors

Jorge De Leon¹, Farhan Ahmad², Kavina Patel², Frank Buttacavoli¹

Affiliations

¹ Department of Orthopaedics, University of Texas Health at San Antonio, San Antonio, TX, USA.
² Joe R. & Teresa Lozano Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA.

Abstract

A 53-year-old patient with a history of Loeys-Dietz syndrome (LDS) presented with cutout after a right femoral neck fracture treated with a dynamic hip screw. This was treated with conversion total hip arthroplasty (THA), the second reported THA in a patient with LDS and the first in a post-traumatic reconstruction setting. The patient had 2 episodes of posterior hip dislocations within 2 weeks after the operation requiring a revision THA utilizing dual-mobility bearing to achieve stability. LDS is a connective-tissue disorder that is associated with joint hypermobility and spinal deformities, among other features. These factors can affect hip pathology, approaches to treatment, and outcomes. Patients with LDS should have a comprehensive musculoskeletal evaluation and history such as those with Marfan syndrome or Ehlers-Danlos syndrome, especially if undergoing THA. Further research on the implications of LDS on the hip and spine should be performed.

Keywords: Hip-spine syndrome; Loeys-Dietz syndrome; Orthopaedic surgery; Spinopelvic relationship; Total hip arthroplasty.