L5-S1 Discoligamentous Distraction Injury following Bilateral Total Hip Arthroplasty Using an Anterior Approach: A Case Report

Abstract

Although acute spinal injury is rarely reported to complicate total hip arthroplasty (THA), its consequences can be devastating. We present a case of L5-S1 discoligamentous dissociation following single-stage bilateral THA performed sequentially through an anterior approach with a traction hemi-table applied on the operated leg. Internal fixation L5-S1 was required, resulting in prolonged recovery, but without relevant long-term sequelae. Pre-operative assessment of the spine is recommended when considering these procedures to evaluate the risk for this potentially severe complication. Particularly, lateral position may be favoured to avoid extension stresses of the spine. An anterior approach may have to be avoided, as it requires hyperextending the hip. A staged procedure may also be preferred to a single-anaesthesia bilateral procedure, limiting duration of potentially harmful positioning.

Keywords

• discoligamentous injury
• spinal injury
• bilateral total hip arthroplasty
• anterior approach
• direct anterior approach
• complication