Abstract
Introduction
Hip Arthrodesis had been considered as a useful surgical option in young adult patient with high activity demands suffering from osteoarthritis of the hip. Although the procedure surely eliminates pain of the hip joint, it can also cause disorders of the adjacent joints in addition to the complete loss of motion, might consequently deteriorate the activity of daily living. The purpose of this retrospective study was to investigate the efficacy and drawback of hip arthrodesis, focusing on the effect of this procedure on the adjacent joints.
Materials and Methods
From 1976 to 1989, 29 hip arthrodesis were performed and 22 hips were followed up (1 died, 6 lost). Disorders led to arthrodesis were septic arthritis (1 hip), post-traumatic (1), osteonecrosis (1), primary osteoarthritis (3), and secondary osteoarthritis due to DDH (16). The average age at surgery was 38 years (range, 19–53 years, 6 men and 16 women). Hip arthrodesis was indicated for young active adults with end stage osteoarthritis, who had normal or mild osteoarthritis in contralateral hip and needed physical labor. The hip was positioned in 30 degrees of flexion, 0 to 5 degree of external rotation, and 0 to 5 degree of abduction. Clinical and radiographic assessment was done for these patients. The clinical follow-up consisted of questionnaire which assessed ability of typical Japanese daily living movement and patient's satisfaction. The condition of the adjacent joints was evaluated clinically and radiographically.
Results
After an average follow-up of 22 years (range15-28), no patients complained of pain in the fused hip joint. On the other hand, pain in the adjacent joints was seen frequently. Seventeen (77%) of 22 patients had low back pain and one of these patients, who had severe low back pain, required conversion of arthrodesis to THA. Ten patients (45%) had contralateral hip pain and 8 (36%) of whom subsequently needed THA. All patients who required THA had early stage osteoarthritis when they underwent arthrodesis. Ten patients (45%) had knee pain (5 in the ipsilateral and 5 in the contralateral knee). Radiographic progression of osteoarthritis in adjacent joints was also seen frequently, namely, 9 in lumbar spine, 11 in contralateral hip, 6 in ipsilateral and 6 in contralateral knee. Although pain in the involved hip disappeared, activity of daily living was severely deteriorated (impossible to clip nail: 88%, ride a bicycle: 94%, use a Japanese toilet: 75%, sit in Japanese style: 50%). As a result, only 4 patients (18%) were satisfied with the hip arthrodesis.
Discussion
The satisfaction of hip arthrodesis was unexpectedly poor despite of pain relief of involved hip joint. One of essential reasons was activity of daily living in Japanese style, which requires relatively deep flexion in hip and knee. Compensation of limited movement in hip might cause pain and progression of osteoarthritic change in adjacent joints. Another vital reason was that we indicated this procedure for bilateral DDH case whose contralateral hip had early stage osteoarthritis, ended up with THA in most cases.
