Epidural hematoma after total hip arthroplasty in ankylosing spondylitis patient

RATIONALE Ankylosing spondylitis (AS) can affect the hip joint, causing deformity and disability. Total hip arthroplasty can obviously relieve the pain of the hip joint, and reconstruct the function of hip joint. Epidural anesthesia in this patient population has high risk of epidural hematoma, but the reason is unclear. PATIENT CONCERNS A 44-year-old man diagnosed with AS underwent total hip arthroplasty. DIAGNOSES Six days after operation, he was diagnosed epidural hematoma. INTERVENTIONS Laminectomy and decompression surgery was performed. OUTCOMES At the last follow-up, he recovered the feeling and function of lower limbs. A literature review was undertaken to understand the incidence and risk factors. The incidence of spinal hematoma in this population is high and only probable risk factors are reported without further research. LESSONS Based on our review and the illustration of this case, AS patients have both lumbar and hip bony fusion. The exact bone canal caused by the lumbar puncture needle may play an important role in epidural hematoma. General anesthesia may be a better choice for this special patient cohort.