Hip Arthrodesis

Indications

• End stage hip disease in a patient not a candidate for hip arthroplasty
• A reconstructive option following tumor resection when there is insufficient bone remaining to support a prosthetic joint replacement
• A reconstructive option following failure of joint replacment
• A modification of lower extremity amputation for limb salvage for tumor resection, a hip rotation plasty

Planning

• Exposure
• Bone preparation
• Positioning
• Fixation
• Managment of the abductor mechanism
• Planning for the future

Primary Arthrodesis for Arthritis with no Deformity

Positioning

• Lateral decubitus position
• Position patient in ideal positon of fusion using bean bags
  • Hip flexion 30 degrees
  • 10 degrees of adduction
  • 15 degrees of external rotation
• Form bean bags around pelvis and lower limbs in this position
• Check an Xray

Surgical Approach

• Use a straight lateral incision
• Classic trochanteric osteotomy, carefully preserving the abductors
• Anterior hip capsulectomy

Arthrodesis

• Expose the acetabulum and carefully ream the acetabulum
• Use corresponding femoral head resurfacing reamer to create a pencil in cup fit femur to acetabuluum
• Reduce the hip
• Contour a Cobra plate and fix to the supraacetabular bone

• Use an outrigger compression device to compress the femur to the acetabulum
• Complete the fixation to the ffemur using compression screws.
• Check an X-Ray
• Reattach the trochanter to near anatomical position to facilitate future take down if necessary.

Postoperative Care

Include immediate postoperative care and rehabilitation

Complications

• Pseudarthrosis rate 0 - 10%
• Femoral fractures develop in 5 - 15%
• Back pain in ~ 60% (long term, usually ~ 25 years post op)
• Pain in the knee 50 - 55% (usually after ~ 24 years)
• Fusion in adduction caus hes less back and knee pain than those fused in abduction
• Hip fused in adduction also has lower incidence of degenerative changes in ipsilateral knee and better gait pattern

Outcome

• Later conversion to THR is associated with limp, due to abductor weakness and positive Trendelenburg test. Conversion to THR however, will improve sitting comfort, may improve level of function, reduce back pain and knee pain.

References

1. Robinson AH, Palmer CR, Villar RN: Is revision as good as primary hip replacement? A comparison of quality of life. J Bone Joint Surg Br 1999;81:42--45.
2. Siebenrock KA, Scholl E, Lottenbach M, Ganz R: Bernese periacetabular osteotomy. Clin Orthop 1999;363:9--20.
3. Wright JG, Rudicel S, Feinstein AR: Ask patients what they want: Evaluation of individual complaints before total hip replacement. J Bone Joint Surg Br 1994;76:229--234.
4. Dorr LD, Luckett M, Conaty JP: Total hip arthroplasties in patients younger than 45 years: A nine- to ten-year follow-up study. Clin Orthop 1990;260:215--219.
5. Ortiguera CJ, Pulliam IT, Cabanela ME: Total hip arthroplasty for osteonecrosis: Matched-pair analysis of 188 hips with long-term follow-up. J Arthroplasty 1999;14:21--28.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=000078079600004&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=9926948&link_type=MED]
6. Sochart DH, Porter ML: Long-term results of cemented Charnley low-friction arthroplasty in patients aged less than 30 years. J Arthroplasty 1998;13:123--131.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=000072498700002&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=9526204&link_type=MED]
7. Torchia ME, Klassen RA, Bianco AJ: Total hip arthroplasty with cement in patients less than twenty years old: Long-term results. J Bone Joint Surg Am 1996;78:995--1003.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=78/7/995]
8. McLaughlin JR, Lee KR: Total hip arthroplasty in young patients: 8- to 13-year results using an uncemented stem. Clin Orthop 2000;373:153--163.
9. McKellop H, Shen F-W, Lu B, Campbell P, Salovey R: Development of an extremely wear-resistant ultra high molecular weight polyethylene for total hip replacements. J Orthop Res 1999;17:157--167.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=000079838500002&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=10221831&link_type=MED]
10. Schmalzried TP, Callaghan JJ: Wear in total hip and knee replacements. J Bone Joint Surg Am 1999;81:115--136.[Free Full Text|http://www.jaaos.org/cgi/ijlink?linkType=FULL&journalCode=jobojos&resid=81/1/115]
11. Liechti R (ed): Hip Arthrodesis and Associated Problems. Berlin, Germany: Springer-Verlag, 1978.
12. Lipscomb PR, McCaslin FE Jr: Arthrodesis of the hip: Review of 371 cases. J Bone Joint Surg Am 1961;43:923--938.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=43/7/923]
13. Stewart MJ, Coker TP Jr: Arthrodesis of the hip: A review of 109 patients. Clin Orthop 1969;62:136--150.[Medline|http://www.jaaos.org/cgi/external_ref?access_num=5774824&link_type=MED]
14. Sponseller PD, McBeath AA, Perpich M: Hip arthrodesis in young patients: A long-term follow-up study. J Bone Joint Surg Am 1984;66:853--859.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=66/6/853]
15. Callaghan JJ, Brand RA, Pedersen DR: Hip arthrodesis: A long-term follow-up. J Bone Joint Surg Am 1985;67:1328--1335.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=67/9/1328]
16. Sofue M, Kono S, Kawaji W, Homma M: Long term results of arthrodesis for severe osteoarthritis of the hip in young adults. Int Orthop 1989;13:129--133.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=A1989U933500008&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=2744915&link_type=MED]
17. Gudmundsson G: Function following arthrodesis for coxarthrosis with special reference to the mobile hip. Acta Orthop Scand Suppl 1972;141:1--79.[Medline|http://www.jaaos.org/cgi/external_ref?access_num=4510128&link_type=MED]
18. Roberts CS, Fetto JF: Functional outcome of hip fusion in the young patient: Follow-up study of 10 patients. J Arthroplasty 1990;5:89--96.[Medline|http://www.jaaos.org/cgi/external_ref?access_num=2319254&link_type=MED]
19. Barnhardt T, Stiehl JB: Hip fusion in young adults. Orthopedics 1996;19:303--306.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=A1996UE58700003&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=8786920&link_type=MED]
20. Sofue M, Kono S, Kawaji W, Homma M: Long term results of arthrodesis for severe osteoarthritis of the hip in young adults. Int Orthop 1989;13:129--133.
21. Ahlbäck SO, Lindahl O: Hip arthrodesis: The connection between function and position. Acta Orthop Scand 1966;37:77--87.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=A19667874800007&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=5940060&link_type=MED]
22. Gore DR, Murray MP, Sepic SB, Gardner GM: Walking patterns of men with unilateral surgical hip fusion. J Bone Joint Surg Am 1975;57:759--765.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=57/6/759]
23. Karol LA, Halliday SE, Gourineni P: Gait and function after intra-articular arthrodesis of the hip in adolescents. J Bone Joint Surg Am 2000;82:561--569.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=82/4/561]
24. Murphy SB, Ganz R, Muller ME: The prognosis in untreated dysplasia of the hip: A study of radiographic factors that predict the outcome. J Bone Joint Surg Am 1995;77:985--989.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=77/7/985]
25. Hauge MF: The knee in patients with hip joint ankylosis: Clinical survey and bio-mechanical aspects. Acta Orthop Scand 1973;44:485--495.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=A1973Q942600014&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=4771281&link_type=MED]
26. Price CT, Lovell WW: Thompson arthrodesis of the hip in children. J Bone Joint Surg Am 1980;62:1118--1123.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=62/7/1118]
27. Hardinge K, Murphy JC, Frenyo S: Conversion of hip fusion to Charnley low-friction arthroplasty. Clin Orthop 1986;211:173--179.
28. Strathy GM, Fitzgerald RH Jr: Total hip arthroplasty in the ankylosed hip: A ten-year follow-up. J Bone Joint Surg Am 1988;70:963--966.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=70/7/963]
29. Kilgus DJ, Amstutz HC, Wolgin MA, Dorey FJ: Joint replacement for ankylosed hips. J Bone Joint Surg Am 1990; 72:45--54.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=72/1/45]
30. Reikerås O, Bjerkreim I, Gundersson R: Total hip arthroplasty for arthrodesed hips: 5- to 13-year results. J Arthroplasty 1995;10:529--531.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=A1995RT19900019&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=8523014&link_type=MED]
31. Hamadouche M, Kerboull L, Meunier A, Courpied JP, Kerboull M: Total hip arthroplasty for the treatment of ankylosed hips: A five to twenty-one-year follow-up. J Bone Joint Surg Am 2001; 83:992--998.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=83/7/992]
32. Amstutz HC, Sakai DN: Total joint replacement for ankylosed hips: Indications, technique, and preliminary results. J Bone Joint Surg Am 1975;57:619--625.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=57/5/619]
33. Kreder HJ, Williams JI, Jaglal S, Axcell T, Stephen D: A population study in the province of Ontario of the complications after conversion of hip or knee arthrodesis to total joint replacement. Can J Surg 1999;42:433--439.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=000084038700011&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=10593244&link_type=MED]
34. Finerman GAM, Dorey FJ, Grigoris P, McKellop HA (eds): Total Hip Arthroplasty Outcomes. New York, NY: Churchill Livingstone, 1997.
35. Garvin KL, Pellicci PM, Windsor RE, Conrad EU, Insall JN, Salvati EA: Contralateral total hip arthroplasty or ipsilateral total knee arthroplasty in patients who have a long-standing fusion of the hip. J Bone Joint Surg Am 1989;71:1355--1362.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=71/9/1355]
36. Romness DW, Morrey BF: Total knee arthroplasty in patients with prior ipsilateral hip fusion. J Arthroplasty 1992;7:63--70.[Medline|http://www.jaaos.org/cgi/external_ref?access_num=1564467&link_type=MED]
37. Rittmeister M, Starker M, Zichner L: Hip and knee replacement after longstanding hip arthrodesis. Clin Orthop 2000;371:136--145.
38. Lindahl O: Determination of hip adduction, especially in arthrodesis. Acta Orthop Scand 1965;36:280--293.[Web of Science|http://www.jaaos.org/cgi/external_ref?access_num=A19657161500008&link_type=ISI][Medline|http://www.jaaos.org/cgi/external_ref?access_num=5850352&link_type=MED]
39. Fiddian NJ: Arthrodesis of the hip, in Reynolds D, Freeman M (eds): Osteoarthritis in the Young Adult Hip: Options for Surgical Management. Edinburgh, UK: Churchill Livingstone, 1989, pp 155--168.
40. Matta JM, Siebenrock KA, Gautier E, Mehne D, Ganz R: Hip fusion through an anterior approach with the use of a ventral plate. Clin Orthop 1997;337:129--139.
41. Barmada R, Abraham E, Ray RD: Hip fusion utilizing the cobra head plate. J Bone Joint Surg Am 1976;58:541--544.[Abstract/Free Full Text|||\|http://www.jaaos.org/cgi/ijlink?linkType=ABST&journalCode=jobojos&resid=58/4/541]
42. McGraw RW, Duncan CP, Beauchamp CP: Arthrodesis: The Vancouver Technique, in Sledge CB (ed): Master Techniques in Orthopaedic Surgery: The Hip. Philadelphia, PA: Lippincott-Raven, 1998, pp 197--207.
43. Beauchamp CP, Duncan CP, McGraw RW: Abstract: Don’t throw away the reamers: A new technique of hip arthrodesis. J Bone Joint Surg Br 1985;67:330.

Related Topics

Include links to related pages