Updated: 10/12/2016

Hip Arthrodesis

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Evidence
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https://upload.orthobullets.com/topic/5034/images/hiparthrodesis.jpg
https://upload.orthobullets.com/topic/5034/images/lateral approach.jpg
https://upload.orthobullets.com/topic/5034/images/anteriorhipplating.jpg
Introduction
  • Used for management of advanced hip arthritis in a select group of patients
    • its utility has decreased with advances in THA technology
  • 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
  • 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
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
Surgical 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
 

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Questions (1)

(OBQ07.177) You are caring for an 18-year-old boy with severe hip arthritis and pain from a missed slipped capital femoral epiphysis. You decide that a hip arthrodesis is the best treatment option. What is the optimum position for a hip arthrodesis to maximize function and prevent complications? Review Topic | Tested Concept

QID: 838
1

0° external rotation, 0° adduction, 0° hip flexion

0%

(14/3154)

2

5° external rotation, 5° adduction, 20° hip flexion

48%

(1519/3154)

3

5° external rotation, 15° abduction, 5° hip flexion

28%

(874/3154)

4

15° external rotation, 0° adduction, 20° hip flexion

14%

(448/3154)

5

15° external rotation, 15° abduction, 5° hip flexion

9%

(277/3154)

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CASES (1)
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