The Hip - book
Home » Joints » Hip » Hip Arthrodesis

Hip Arthrodesis

- Discussion:
    - hip fusions acn occur spontaneously following childhood sepsis or after ORIF of acetabular fractures (secondary to heterotopic bone).
    - they also occur spontaneously due to ankylosing spondylitis;
    - surgical fusions are performed for young adults with advanced arthritis;
    - indications:
           - desire to return to near-normal physical activity with manual labor;
           - 20 yrs years after surgery, 80% of pts w/ hip arthrodesis performed at relatively young age were working & satisfied w/ their results;
           - relief of pain;
           - young male;
    - requirements:
           - normal contralateral hip, ipsilateral knee, and a low back are prerequisites in preoperative planning;
           - pain and instability of the ipsilateral knee may also occur in pts w/ a fused hip;
           - pts w/ long-standing hip fusion may develop progressive nonradicular pain in the low back that worsens with activity;
           - no cardiovascular pathology:
                  - rate of oxygen consumption is  32% greater than normal;
                  - average walking speed was 84% of normal gait velocity;

- Surgical Considerations:
    - position of hip fusion:
            - neutral abduction, exteran rotation of 0-30 deg &, 20-25 deg of flexion;
            - avoid abduction and internal rotation;
            - this position is design to minimize excessive lumbar spine motion and opposite knee motion which helps minimize pain in these regions;
    - exposure:
            - may use either an anterior or posterior approach inorder to dislocate the hip and to remove the joint surfaces;
    - fixation:
            - AO Cobra Plate: stable but disrupts abductors:
            - trans-articular sliding hip screw:
                   - lag screw is inserted across the joint and just superior to the dome of the acetabulum;
                   - disadvantage of this technique includes poor fixation (due to large lever arm and the resulting torque on the lever arm) and need 
                          for postoperative hip spica casting;
    - osteotomy:
            - some authors advocate supra-acetabular osteotomy or subtrochanteric osteotomy for improved positioning;
            - references:
                   - Combined hip fusion and subtrochanteric osteotomy allowing early ambulation
                   - Osteotomy as an aid to arthrodesis of the hip.  
    - contra-lateral epiphysiodesis:
            - limb-length discrepancy resulting from disruption of the proximal femoral epiphysis has a negative effect on gait mechanics;
            - consider epiphysiodesis of the distal femoral epiphysis (at the appropriate age) inorder to equalize leg length descrepancy;

- Complications:
    - expect that most patients will have complications which are either major or minor;
    - malposition (most common)
    - nonunion
    - leg length descrepancy (common and can be severe enough to require lift);
    - DJD or instability of ipsilateral knee, back, and contralateral hip;
           - low back pain is present in over 50% of patients with hip fusion;
    - in the study, by Karol LA, et al (2000), the authors performed gait analysis on hip fusion patients;
           - gait analysis showed excessive motion in the lumbar spine and the ipsilateral knee in all nine patients;
           - abnormal motion led to pain as the duration of follow-up increased, and all patients who had been followed for four or more years 
                   after the arthrodesis complained of back pain;
           - excessive hip flexion may cause excessive compensatory lumbar lordosis (leads to back pain);
           - more than 10 deg of hip adduction or abduction may lead to varus/valgus knee instability;
           - Gait and function after intra-articular arthrodesis of the hip in adolescents.

- Conversion of Fused Hip to THR

The treatment of the painful hip in cerebral palsy by total hip replacement or hip arthrodesis.

Hip arthrodesis in young patients. A long-term follow-up study.

Thompson arthrodesis of the hip in children.

Hip arthrodesis. A long-term follow-up

Contralateral Total Hip Arthroplasty or Ipsilateral Total Knee Arthroplasty in Patients Who Have a Long-Standing Fusion of the Hip.

Hip fusion in young adults. Using a medial displacement osteotomy and cobra plate.

Walking patterns of men with unilateral surgical hip fusion.

Joint replacement for ankylosed hips.

Total knee arthroplasty in patients with prior ipsilateral hip fusion.

Intra-articular hip arthrodesis without subtrochanteric osteotomy in adolescents: technique and short term follow up.