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Hip Arthrodesis

  • Pseudarthrosis rate 10%
  • Femoral fracture 10%
  • Back pain 60%
  • Knee Pain 50%
  • Fusion in adduction
    • less back & knee pain than those fused in abduction
    • lower incidence of degenerative changes in ipsilateral knee & better gait pattern

Position

  • 50 Adduction
  • 40 Flexion
  • Neutral rotation

Later conversion to THR

  • limp due to abductor weakness
  • positive Trendelenburg test
  • Conversion to THR will however improve sitting comfort, may improve level of function, reduce back pain & knee pain

Operative Technique

  • Anterior Ilio-femoral approach, expose & dislocate hip
  • Remove cartilage from femoral head & acetabulum
  • All avascular bone must be removed
  • Reduce joint & position 30° flexion, neutral Ab / Ad-duction to 5 adduction & neutral external rotation. (using fracture table have leg horizontal as 30° lumbar lordosis produced in patients with mobile lumbar spine)
  • Add extra articular graft if required
  • Internal fixation using either CHS, Cobra plate, DC Plate, Cannulate screws etc
  • Hip spica 2-4/12 & encourage WB
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