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Implant survivorship is greater than 95% at 20 years following conversion to arthroplasty
5%
220/4170
Conversion to arthroplasty should not be performed if arthrodesis is more than 15 years old
7%
291/4170
Function of gluteus medius is predictive of ambulatory status
84%
3487/4170
Rate of complication is equivalent to primary total hip arthroplasty
2%
81/4170
Incidence of nerve palsy is comparable to primary total hip arthroplasty
1%
61/4170
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Hip arthrodesis is a viable solution for the very young laborer with debilitating hip disease. Conversion to total hip arthroplasty once the patient has become less active has been clinically successful in relieving adjacent knee and low back pain although complications are more frequent than primary hip arthroplasty. Incompetence of the gluteal muscle groups was predictive of poor ambulatory outcome. Preoperative EMG studies can be useful to evaluate the competence of the gluteal musculature prior to surgery. Joshi et al reviewed 208 hip fusions converted to total hip arthroplasties. 79% reported minimal pain and good to excellent range of motion. Arthroplasty survival was 96% at 10 years, 93% at 15 years, and 73% at twenty years. Complications included nerve palsy in 7% of hips and heterotopic ossification in 14% of hips. Hamadouche et al reports on 45 hip fusions converted to arthroplasty. Satisfactory outcome was reported in 91%. A radiographic example is provided in illustration A (Morsi. Journal of Arthroplasty Sept. 2007). Incorrect Answers: 1) Implant survival was 97% at 8 years. Other studies have demonstrated much poorer clinical outcomes including survivorships of less than 70% at 10 years. 2) There is no time limit for conversion as successful revision arthroplasty has been documented 30 years following arthrodesis. 4) Complication rates are increased with conversions. 5) Nerve palsy risk is also increased during conversion.
4.1
(20)
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