Resection Arthroplasty and Hip Joint Fusion

Abstract

The continued improvement in both prosthetic bearing technology and the methods by which prosthetic implants are fixed to host bone have reduced the frequency of both wear particle induced osteolysis and aseptic implant loosening after total hip arthroplasty. Improvements in surgical technique and operative efficiency have helped reduce complications related to infection and intraoperative soft-tissue damage. Infection rates in many high volume joint replacement centers have stabilized below 1 % (J Bone Joint Surg Am. 89(8):1675–84, 2007). Even in the setting of significant bone destruction, viable options for reconstruction via revision arthroplasty often exist. As such, the need for salvage operations for failed total hip arthroplasty has diminished.

However, the expanding indications for hip arthroplasty will continue to drive the demand for total hip arthroplasty, even in the younger patient cohort (J Bone Joint Surg Am. 89(4):780–5, 2007). Periprosthetic infection and wear related complications will continue to produce situations in which there are limited or no options for revision reconstruction procedures. Although the indications have narrowed, there will remain a place for resection arthroplasty of the hip. Hip joint arthrodesis can be performed as a salvage operation for failed total hip arthroplasty. However, the indications are narrow and the outcomes are not comparable to primary hip joint fusion. Indeed, most patients deemed “unreconstructible” after failure of revision hip arthroplasty will not be candidates for fusion because of previous destruction of supporting bone stock.