1. CONVERSION FROM FUSED TO TOTAL HIP ARTHROPLASTYBY
PROF J.A.O MULIMBA

2. Problems of fused hip Social Sitting in transport vehicles
Other activities of daily living
Mobility
Limited and awkward
High incidence of low back pain
Effect on Ipsilateral knee
Effect on contralateral hip

3. What are the reasons of conversion
Activity of daily living(ADL)
Painful Pseudoarthrosis
Back pain
Ipsilateral knee pain
Contralateral hip pain
Whitehouse MR, Duncan CP.
JBJs(Br) Nov 2013 Sept. 95-B: 11suppl,

4. Things to check before surgery
Leg length discrepancy
Opposite hip
Ipsilateral knee
Patient expectations – Don’t promise heaven
Note
It has been reported in some series that post operative complications are many:
Failure rate
Increased dislocation
Pain

5. Noted Complications in other series
Nerve palsies – quite a large number.
Heterotopic calcification.
Reduced motion.
Some required revision arthroplasty.
Recurrence of pain in a few.
Mean age 51 years.
Sah AP, Estolk DM. Dislocation Rate After conversion
JBJs (AM), 2008,90(3)

6. In this communication No of patients – 6 Gender -5 female, 1 male Age;
47 years
43 years
34 years
36 years
29 years
30 years
Average age 36.5 years
Reason for fusion
- Infection 3
- Trauma
-Unknown 1

7. Reasons for wanting conversion
ADL
Awkward gait
Pain opposite hip
LBP
Restoration of leg length 4
Note
Most patients had more than one reason

8. Methodology All patients done under GA Patient in lateral position
Used standard lateral approach
Cut always very close to the pelvic end of neck
Acetabulum created
Femoral reaming with neck conservation
Limited female acetabulum to 48 mm
Fixed the acetabulum shell with 1 or 3 screws

9. Methodology cont; Used insert of 28mm inside diameter
Femoral canal reamed to level easily achieved by standard reamer
Femoral component equivalent to largest reamer used
Used neck length closest to the correction of LLD
Trial reduction was always made but failed
The wound was closed
ST pin was put at tibial tuberosity

10. Methodology Cont; Patient taken back to the ward
Heavy traction applied for one week
After one week patient taken back to the theatre
Under general anaesthesia closed reduction tried – failed
Wound opened , reduction easily achieved
All reductions were stable
Wound closed

11. Methodology cont; Following day check X-ray done
Patient mobilized by physiotherapist
All patients discharged within 1 week of second operation

12. Post Op Two patients had sciatic nerve palsy 1 male
1 female – recovered after almost a year
Pts were slower in getting going
Limping took much longer to disappear
Two patients did not get leg length restored
Not a single dislocation occurred
*Shortest follow up so far – 2 years
Only disappointment is failed LLD

17. Referrences:
1) Joshi AB, Markovic Ljubisa, Hardinge K, Murphy JCM. Conversion of fused hip to total hip arthroplasty, J.Bone J Surg AM; 2002: 84(8): 1335 – 1341.
2) Ciitings DJ, Courtney PM, Ashley, BS,et al Diagnosing infection in patients undergoing conversion of prior internal fixation to total hip arthroplasty. J.Arthr. 2017; 32: 241 – 245.
3) Newman JM,Webb MR, Klika AK, et al Quantifying Blood loss and Transfusion Risk After Primary Vs Conversion Total Hip Arthroplasty. J.Arthro. 2017; 32 (6): 1902 – 1909.

18. Thank you