Conversion of hip arthrodesis to total hip arthroplasty, A case study Dr L.K. Lelei, Dr Ruto T.K

INTRODUCTION  Arthrodesis of the hip is a means of treating painful and damaged hips, especially in the young population.  Increasing experiences in THR have led to restrictive indications for arthrodesis and to more and more total hip arthroplasty.

INDICATIONS For Arthrodesis  young active laborers with painful unilateral ankylosis after infection or trauma  salvage for failed THA (most common)  neuropathic arthropathy  tumor resection

Conversion of fusion to THA Indications  severely debilitating back pain (most common)  severe ipsilateral knee pain with instability  severe contralateral hip pain

CASE REPORT A 24 year old female who presented with history of road traffic accident in 2003 sustaining injury and dislocation of the left hip. She was managed conservatively, with skin traction for about 2/12. She was then done surgical fusion of the left hip. The duration of arthrodesis was 12 years after which she presented with marked tenderness on the left hip joint that worsens on ambulation

 Radiological image

 Patient was taken OT, Via Anterolateral approach, Arthrodesis taken down, Un Cemented THR done, Signature system.  Un Cemented Total Hip Replacement done.

The duration of hospital stay after THR was 14 days. Post operatively, patient had complains of pain and difficulty in ipsilateral knee flexion which was managed by analgesics, physiotherapy and locked hinge knee brace at months after surgery, patient has shown satisfactory hip score using the oxford hip scoring system. Only has occasional numbness on the left lower leg and slight pain when bending.

CONCLUSION  Hip fusion can provide complete pain relief, allowing strenuous activity in patients who are too young to undergo total hip replacement. However, as these patients mature into adolescents and young adults, long term durability of the hip fusion and prospects of multiple revisions are of concern. Therefore, conversion of arthrodesed hip to a total hip replacement is a logical solution to patients with severe arthritis after hip fusion as well as women seeking normal sexual life.

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