Hip arthrodesis in the pediatric population: where do we stand?

Abstract

Reconstructive and salvage procedures have continued to evolve in orthopedic surgery with changing functional demands of the population as well as advances in implants and surgical techniques. What used to be popular or traditional care at some point may eventually become a thing of the past, and this is true as far as many orthopedic surgical procedures are concerned. Understanding the etiology, pathogenesis, and managing and postponing the destructive pathway of osteoarthritis (OA) has been the goal of orthopedists since the specialty began in the early part of 18th century. Options of treating the severe sequelae of an arthritic joint have varied in different treatment eras. Management options have changed from a spectrum of non-treatment and slow suffering to muscle and soft-tissue releases, interposition arthroplasty and eventual extreme options like joint fusion or arthrodesis. The concept and advent of joint replacement surgery started a new era in the management of OA and was a dream come true in many ways. Mobility and stability are achieved together during the arthroplasty (joint replacement) that allowes the patient to maintain a good level of function. Arthroplasty certainly has its pros and cons as we have discovered in the past six decades. Pushing the envelope to younger population has its limitation in terms of longevity of the prosthesis, early loosening, need for repeated revisions that at some point may not be technically possible and risk of infection and disastrous consequences like PE and death associated with the gravity of the procedure. As infrequent as it is in today's clinical practice, arthrodesis of the hip joint has a role and remains a solid option for a well selected case.The purpose of this review is to discuss the current indications in the pediatric population and outline surgical techniques for hip arthrodesis while pointing out limitations and shortcomings.

Lower limb reconstruction for malignant bone tumours in children

“…However, this technique is no longer ‘fashionable’ in Western Europe but should be considered as a valuable solution. 22 …”

The short-term outcomes of hip arthrodesis in children and adolescents with end-stage hip disease

“…Secondly, because optimal bone contact was prioritised at the fusion site, the limb could be placed in the ideal functional position through the osteotomy site (15-40° flexion, 0-10° abduction and 0-10° external rotation). 1,[6][7]24,28 During the immediate postoperative period, patients were placed in skeletal traction for a period of two weeks. This facilitated soft tissue healing and wound review, while maintaining the optimal alignment, and allowed for some initial soft callus formation.…”

“…Management of paediatric and adolescent patients with end-stage hip arthritis remains challenging, and the trends in management have changed over time. 1,2 When hip preservation is not possible, the treatment options are either total hip replacement (THR) or hip arthrodesis. There is limited evidence to support the choice of one procedure over the other.…”

“…[4][5][6][7] The goals of hip arthrodesis are a pain-free, stable hip joint that will improve function. 1 The procedures' success was first reported in 1894. Since then, a variety of fusion techniques and modifications have been published, resulting in improved union rates with a decrease in complications.…”

Prediction of adolescent pelvis development using femoral head and acetabulum growth in a longitudinal radiographic study

“…Prior studies have shown problems such as prosthetic loosening, wear, osteolysis, and shortening of prosthetic life span occur at a higher frequency in the pediatric population (Shrader, 2012). Compared to adults, pediatric THA is performed for higher levels of severity in conditions such as Legg‐Calve‐Perthes disease, slipped capital femoral epiphysis, developmental dysplasia of the hip, and avascular necrosis (Bittersohl et al, 2011; Sedrakyan et al, 2014), requiring more complex surgery. Furthermore, increased activity level in youths make surgeons wary of increased chance of revision (Halvorsen et al, 2019).…”