Abstract
Introduction
Conversion of immovable hip to a total hip arthroplasty provides a solution, improving function, reducing back and knee pain, and slowing degeneration of neighboring joints associated with hip dysfunction while the mobilization by total hip arthroplasty is rather uncommon and challenging surgery.
Materials and methods
Since 1998 we have performed 28 uncemented total hip arthroplasties for arthrodesed or ankylotic Hip. Among them 25 hips in 24 patients (four males and 20 females) with minimum of six months follow-up were evaluated. Thirteen hips were arthrodesed and twelve hips were ankylotic. One patient had arthrodesed hip in one side and ankylotic one in the other side. The mean age at the surgery was 63 (42 to 80). Two patients were Jehovah's witnesses. All 13 arthrodeses had been performed at other hospitals due to developmental dysplasia (11 hips), tuberculous coxitis (one hip), and infection after osteotomy (one hip). The underlying disease for the ankylosis was tuberculous coxitis for one hip and dysplastic osteoarthritis for 12 hips. Spongiosa Metal Cup (GHE, ESKA Orthodynamics AG, Lübeck, Germany) was used for 21 hips (screw fixation was added for two hips), Alloclassic Cup (Zimmer GmbH, Winterthur, Switherland) for one hip, Bicon Plus Cup (Smith & Nephew AG, Rotkreuz, Switherland) for one hip, and Müller's Reinforcement Ring (Zimmer GmbH, Winterthur, Switherland) for two hips. The bearing couple was ceramic on ceramic (Biolox forte, Ceramtec AG, Prochingen, Germany) for 14 hips, ceramic on polyethylene for eight hips, and metal on metal for three hips. Spongiosa Metal Stem (GHE, ESKA Orthodynamics AG, Lübeck, Germany) was used for 15 hips, SL Plus Stems (Smith & Nephew AG, Rotkreuz, Switherland) for nine hips, and Alloclassic Stem (Zimmer GmbH, Winterthur, Switherland) for one hip. All surgeries were carried out through an anterolateral approach. Twelve hips required the adductor tenotomy against the stiffness. The average follow-up period was 3.7 (0.5 to 10.6) years.
Result
The average total blood loss during total hip arthroplasty was 685 (150 to 2042) milliliters and the average operative time was 102 (64 to 178) minutes. A perforation occurred in one femur. In this patient a plate (used for the previous arthrodesis) was buried in the femoral cortex. Trochanteric fracture occurred in another hip. The average post-operative range of motion was 65 (35 to 100) degrees in flexion, 2 (−10 to 15) in extension, 18 (5 to 30) in abduction, 10 (5 to 20) in adduction, 25 (10 to 45) in external rotation, and 14 (−5 to 30) in internal rotation. We had no postoperative dislocation. One patient required one-stage revision because of the recurrent infection at three years after the primary total hip arthroplasty. In all other patients the implants were stable at the final follow-up.
Conclusions
An immovable hip brings about a lot of inconveniences. Though the surgery involved technical difficulties, it provided a better quality of life for the patients. Mobilization by means of uncemented total hip arthroplasty can be carried out successfully for immovable hips.
