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Updated: Jun 9 2021

Hip Arthrodesis

Images approach.jpg
  • summary
    • Hip Arthrodesis is the fusion of the hip joint most commonly performed for management of advanced hip arthritis in a select group of patients.
    • Common indications include salvage option for a failed THA, and for young active laborers with painful unilateral ankylosis after infection or trauma.
    • Ideal hip fusion position is 20-35° of flexion, 0-5° adduction, 5-10° external rotation.
  • Biomechanics
    • Pathomechanics
      • reduces efficiency of gait by ~50%
      • increases pelvic rotation of contralateral hip
      • increases stress at adjacent joints
    • Biochemistry
      • increases oxygen consumption
      • requires 30% more energy expenditure for ambulation
  • Treatment
    • Primary hip arthrodesis
      • indications
        • salvage for failed THA (most common)
        • young active laborers with painful unilateral ankylosis after infection or trauma
        • neuropathic arthropathy
        • tumor resection
      • contraindications
        • active infection
        • severe limb-length discrepancy greater than 2.0 cm.
        • bilateral hip arthritis
        • adjacent joint degenerative changes
          • lumbar spine
          • contralateral hip
          • ipsilateral knee
        • severe osteoporosis
        • degenerative changes in lumbar spine
        • contralateral THA
          • increased failure rate (40%) in THA when there is a contralateral hip arthrodesis
    • Conversion of fusion to THA
      • indications
        • severely debilitating back pain (most common)
        • severe ipsilateral knee pain with instability
        • severe contralateral hip pain
      • techniques
        • obtain preoperative EMG to assess the status of the gluteus medius
          • a constrained acetabular component is required if the abductor complex is nonfunctional
      • outcomes
        • clinical outcome is dependent on abductor complex function
        • the presence of hip abductor complex weakness or dysfunction
          • requires prolonged rehabilitation
          • severe lurching gait may develop
  • Techniques
    • Hip arthrodesis
      • goals
        • achieve apposition of arthrodesis surfaces, obtain rigid internal fixation and promote early mobilization
      • optimal position
        • optimal positioning for function and limited effect on adjacent joints
          • 20-35° of flexion
          • 0°-5° adduction
          • 5-10° external rotation
            • avoid abduction as it creates pelvic obliquity and increased back pain
      • approach
        • lateral approach with trochanteric osteotomy is preferred
          • important to preserve the abductor complex
          • avoid injury to the superior gluteal nerve
        • anterior approach to hip is also popular
      • instrumentation
        • cobra plating
  • Complications
    • Low back pain
      • can be improved by taking down hip arthrodesis, but overall improvement depends on abductor function
    • Ipsilateral knee degeneration and laxity
    • Contralateral hip degeneration
  • Prognosis
    • Provides pain relief and reasonable clinical results in most patients
    • Success may be limited by adjacent joint degeneration in 60% of patients
      • lumbar spine, ipsilateral knee or contralateral hip may be affected
      • low back pain and arthritic ipsilateral knee pain are the most common symptoms
        • may start within 25 years of hip arthrodesis
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