Total Hip Arthroplasty for Fused Hips; Planning and Techniques

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].…”

“…QOL was lower after conversion of hip arthrodesis than after conventional PTHA in contrast to reports that conversion may achieve a success rate similar to that of a PTHA [36,40,49]. They reported no differences observed either in functional scores between conversion of fused hips to THA and revision THA, as observed by Peterson et al [53], or in patient satisfaction between the three studied cohorts [57].…”

“…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]. To address this controversy, we compared THA after hip arthrodesis and PTHA to determine whether these procedures would produce similar (1) functional results, (2) maintenance of scores, (3) complications and failures, (4) survivorship of the arthroplasty, and (5) patient satisfaction.…”

“…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.…”