Role of hip arthrodesis in current practice: long term results following conversion to total hip arthroplasty

Abstract

Arthrodesis remains a sensible and safe treatment option maintaining independent mobility without multiple operations or significant bone loss for 20-30 years which subsequently can be successfully converted to an arthroplasty.

Is Total Hip Arthroplasty after Hip Arthrodesis as Good as Primary Arthroplasty?

“…Richards and Duncan [57] used only self-administered QOL outcome questionnaires in their study, but we think the combination of a surgeonadministered hip-specific score (HHS) measuring hip function, and a patient self-administered health-related QOL survey allows for a more global assessment of patients [43]. Our data confirm that of other studies [29,36,40,49,54,58,65] documenting improved function and QOL after conversion and similar to the improvements after a PTHA ( Table 5). The HHSs achieved by our patients after conversion were similar to those reported in other studies [53,58,62] and, although lower than those for the PTHA for the general population [37,42], they were comparable or better than those obtained in other particular populations such as young patients, patients with high demands, or patients with an important handicap secondary to multivariate hip disorders or polyarticular impairment [43,56].…”

“…However, samples of patients with fused hips are scarce. Only Joshi et al [36] and Sirikonda et al [65] have reported more patients than in our study (Table 5). We used clinical rating systems with high responsiveness and effect size [17,33,51].…”

“…However, some authors believe that function, range of mobility, muscle strength, persistence of limp, and need for assistive walking aids are less satisfactory after conversion of a fused hip to a THA compared with a conventional PTHA [40,52,53,55,57,62,69], with a rate of major complications ranging from 15% to 54% [40,53,55,57,62,65,73,74]. However, some consider it a satisfactory procedure [30,36,54,62], achieving similar improvement of symptoms, success rate, patient satisfaction, and survivorship as a PTHA [4,40,49].…”

“…Complete or near complete relief is noted in 73% to 80% of patients with preoperative back pain [30,40] and in 66% of patients with knee pain [40]. Regarding pain and function in the surgically treated hip, 79% to 85% of hips are painfree or with minimal pain [36,45,64], 79% have ''good-toexcellent'' ROM [36], and 83% have ''good-to-excellent'' function [36], obtaining an average postoperative hip flexion between 708 and 1028 [29,40,45,49,54,65] and improvement in walking [29]. Overall function and walking improves after conversion [54,55,58].…”

“…Survival of the converted THA ranges from 74% to 96% at 10 years [29,36,53,57] and 73% at 26 years [36]. Between 75% and 100% of patients are satisfied with the procedure [29,36,40,45,49,55,57,62,65,73], and they generally are pleased with the outcome even if factors such as range of mobility, muscle strength, LLD, persistence of limp, and need of assistive walking aids are less satisfactory in converted hips compared with hips that had conventional primary THA [40,52,55,69]. A patient's satisfaction with the obtained outcome may be related more to the global change achieved in QOL than to 'objective' data assessed by the surgeon.…”