Hip Arthrodesis

Indications

  • Young patients (<30 years) with debilitating arthritis
  • Previously infected hip with end-stage joint destruction
  • Heavy laborers
    (Resurfacing may be a better option)

Prerequisites

  • Adjacent joints (spine, knee, other hip) must be normal
  • No active sepsis
  • No major limb length discrepancy (fusion will cause further shortening)

Position of Fusion

  • 30 degrees flexion: Clears foot and allows comfortable sitting
  • 5 degrees adduction: Prevents abductor lurch
  • 5 degrees external rotation: Prevents tripping

Instrumentation

  • Rigid fixation of well-opposed joint surfaces with fixed-angle plates

Results & Complications

  • Generally good; reports in children show >20 years of good function
  • Failure often due to adjacent joint disease, which is the most common reason for conversion to Total Hip Replacement (THR)
  • Complications:
    • 50% experience back pain
    • 40% have ipsilateral knee pain
    • 20% have contralateral hip pain
    • Non-union is uncommon but can occur

Conversion to THR

  • Results are not as good as primary THR
  • Challenges include:
    • Soft tissue contracture and wasting
    • Functional abductors are critical for good outcomes
    • Risks: Instability, limp, and pain
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