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Returning Motion to a Fused Hip
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Posted on: 11/11/2003
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Here's a true conversion story. Doctors at the Joint Replacement Center of Korea converted a fused hip into a moveable joint. They did this with a total hip replacement (THR). Actually, 86 patients had a fused hip joint converted to a THR.
There are varying reports on the results of THR for fused hips. Some studies show the implant lasts for years after the conversion surgery. Others report a high failure rate. Younger patients and those who have already had other surgery on that hip are more likely to fail.
THRs can be put in with or without cement. This is the first study to look at cementless THR when converting from a fused hip.
The researchers set out to answer four questions:
How many THRs loosen after fusion? (And is it the same for a surgical fusion versus a hip that fuses on its own)?
Do more hips loosen with a cemented or a cementless implant?
How much wear does the liner of the hip socket show for each group?
How often does the bone break down in each group (cement versus cementless)?
Patients were X-rayed every year for 10 years. Pain and function were also measured. It turns out that converting from a fused hip to a hip implant gave almost everyone relief from their back pain. Knee pain was also reduced, but not as much as the change in back pain.
Function wasn't measurably better, but the patients were happy to have new mobility in the hip, and they found it easier to get around. They also reported being able to sit comfortably. There was a high rate of liner wear and bone breakdown in both groups.
The authors think the overall good results are from several factors. Surgical methods are improved. Tight muscles and soft tissues are released more completely now. But the operation is difficult and shouldn't be done without careful thought and planning. Patients must be prepared for the possibility of a long and slow recovery.
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References:
Young-Hoo Kim, MD, et al. Total Hip Arthroplasty for the Treatment of Osseous Ankylosed Hips. In Clinical Orthopaedics and Related Research. September 2003. Vol. 414. Pp. 136-148.
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