Conversion of Excision Arthroplasty to Total Hip Arthroplasty

Abstract

After excision arthroplasty of the hip, patients seek conversion to total hip arthroplasty usually due to limb-length discrepancy, persistent limp or Trendelenburg’s gait, dependence on walking aids and pain in contralateral hip, ipsilateral knee or lower back. The surgeon must anticipate the challenges of this surgery such as supra-trochanteric shortening of the limb, contractures around the hip and abductor dysfunction. Post-operative complications commonly seen are dislocation, wound-healing problems, sciatic nerve palsy and recurrence of infection. Though conversion of excision arthroplasty to THA does provide significant clinical improvement, it is important to pre-operatively counsel patients about issues such as persistent limp, dislocation and recurrence of infection after conversion. Patients’ expectations should be attenuated to a realistic level with regard to improvement in hip function as opposed to a primary THA.