Conversion of Arthrodesis to Total Hip Arthroplasty: Clinical Outcome, Complications, and Prognostic Factors of 21 Consecutive Cases
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Although the results of hip arthrodesis compare favorably with those of total hip arthroplasty (THA) in younger patients, long-term consequences such as osteoarthritis of the neighboring joints may necessitate conversion of the arthrodesis to THA.
The purpose of the present study is to assess mid-term clinical outcome and self-perceived improvement in patients who underwent conversion at our department. Secondary aims were incidence of complications and association between patient characteristics and characteristics of the fusions with the outcome of the procedure.
Patients and Methods
The study sample comprised 21 cases in 20 patients. Minimum follow-up was 3 years (mean, 8 ± 6.5 years) in 20 cases. Thirteen patients had surgical hip fusions and 7 (8 hips) had nonsurgical fusions. Mean age at the time of conversion was 58.5 years.
Nineteen out of 21 cases had functioning implants at the latest follow-up visit. According to the Merle d’Aubigné scale, outcome was considered excellent, very good, or good in 15 cases. Lower back pain was reduced in all patients. All but two patients were satisfied after the conversion. The main complications observed included incomplete removal of bone block, intra-operative fractures, dislocation and damage to the femoral artery. Time to conversion and type of fusion had no significant correlation with the clinical outcome.
Conversion THA is a challenging but successful procedure according to the mid-term clinical outcome observed. Our study suggests that, prognostic factors should be used with caution when establishing indications and post-surgical expectations.
Keywordship arthrodesis total hip arthroplasty conversion
We thank Professor Jiménez-García (University Rey Juan Carlos, Madrid) for the statistical analysis and Mr. Thomas O’Boyle for editorial assistance. A video illustrating the surgical technique and these clinical series has been included in the E-Library of the AAOS (San Francisco 2012) and is available upon request.
Conflict of Interest: Manuel Villanueva, MD, PhD; Francisco Borja Sobrón, MD; Javier Parra, MD; Jose Manuel Rojo Manaute MD, PhD; Francisco Chana, MD PhD; Javier Vaquero Martín, MD, PhD have declared that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent was obtained from all patients for being included in the study.
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