BACKGROUND: Performing total hip arthroplasty (THA) or total hip replacement (THR) in hip ankylosis is not a simple procedure. CASE PRESENTATION: We presented a complicated case of a patient with flexion contracture and ankylosis of hip joint due to neglected avascular necrosis of femoral head treated with THR on one thigh, and periprosthetic fracture on the other which was also treated with THR later. One year after the surgery, the both hips function was improved and the patient was able to walk without assistive device. CONCLUSION: Total hip replacement is a modality that could be considered for the treatment of advanced AVNFH and ankylosis of hip joint, with femoral periprosthetic fracture as one of its potential complications.

In developing countries, a large proportion of patients with scoliosis present late, especially the underprivilege, so the curves had become rigid and severe. There is still no consensus about the surgical management of the severe and rigid scoliosis and some literatures suggested that combined anterior and posterior or single-stage posterior-only instrumentation are generally required for the correction of these deformities. We presented three cases of severe rigid scoliosis treated surgically in our center with two staged operation (anterior surgery and posterior instrumentation). A retrospective review was undertaken of patients with severe scoliosis who had undergone two-staged operation in Orthopaedics and Traumatology Department of Prof Ngoerah General Hospital Bali during the period between January 2018 and February 2020. The data was obtained from the hospital’s medical records and archives in our department, included sex, age, the severity and reducibility of the Cobb angle, maturity rate, treatment, length of stay, complications found, and the Scoliosis Research Society: 30 Questionnaire (SRS-30) score before and three months after the surgery. During the period of between January 2018 and February 2020, there were three cases of severe rigid scoliosis who underwent two-staged operation. The two staged operation performed were anterior surgery (soft tissue release, corpectomy, and anterior fusion), and posterior instrumentation (facetetectomy, rotation, stabilization, and fusion). There were one case of intra-operative hypovolemic shock and anemia that could be corrected succesfully. All three patients showed no complaint and the clinical examination showed improvements of the deformity post operatively. There were also improvement of the total SRS-30 score of all three patients after the two staged procedures performed (mean = 4.4) compared to pre-operative score (mean = 3.4). The two-staged operation including anterior surgery and posterior instrumentation is still a safe and effective way in treatment of severe rigid scoliosis.