Arthrodesis

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  • Fusion (Ankylosis) can occur spontaneously following childhood sepsis, following ORIF of acetabular fractures (secondary to heterotopic bone) and in ankylosing spondylitis

  • Unpopular as leads to increased stress on other hip and ipsilateral knee

  • Oxygen consumption 32% greater than normal

  • Average walking speed 84% of normal

 Indication

  • Young patient with unilateral hip disease (usually post-traumatic)

  • Contra-lateral hip, both knees and spine must all be normal

 Technique

The goals of surgical treatment are to achieve bone apposition at the fusion site, rigid internal fixation, and early mobilization.

  • Anterior or posterior approach inorder to dislocate the hip and to remove the joint surfaces

  • AO Cobra Plate: stable but disrupts abductorscobra-plate

  • 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

  • Some authors advocate supra-acetabular osteotomy or subtrochanteric osteotomy for improved positioning

 

Optimal position

  • 25o flexion
  • Neutral – 5o external rotation
  • Neutral or slight adduction
  • Avoid abduction and internal rotation

Results

  •  Hip arthrodesis achieves lasting pain relief and satisfactory clinical results in most patients.
  •  The survivorship of arthrodesis can be limited by symptomatic degenerative disease of the neighboring joints:

    •  The lumbar spine
    • ipsilateral knee, or
    • contralateral hip can demonstrate joint degeneration.
  • Low back pain and instability and osteoarthritis of the ipsilateral knee are the most common problems.
  • Occasionally, hip fusion conversion to total hip replacement is needed.
  • Conversion of a hip arthrodesis to total hip arthroplasty provides good clinical results in most patients.
  • Trochanteric osteotomy is frequently necessary for surgical exposure.trochanteric-osteotomy
  • Rehabilitation is prolonged because of profound hip abductor weakness and the associated limp.

Complications

  • Non-union
  • Malunion
  • OA of hip, spine, knee 
  • Instability of ipsilateral knee

 

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