Coxarthrosis after traumatic hip dislocation in the adult

Sixteen percent of patients with uncomplicated hip dislocations have posttraumatic arthritis develop. Incidences as high as 88% are reported for patients with dislocations associated with severe acetabular fractures. The surgical treatment of patients with posttraumatic arthritis includes arthroscopy, arthrodesis, osteotomy, and arthroplasty. Although arthroplasty offers the best solution for the painful arthritic hip in the older or inactive patient, the treatment of an active patient in the prime of life with severe osteoarthritis of the hip is problematic. In the younger, active patient, it may be prudent to consider alternative treatment in an attempt to avoid, or delay, total hip arthroplasty. Although improving the longevity of primary arthroplasty is desirable, measures to prevent or delay the onset of the osteoarthritis seem more appropriate. Arthroscopic lavage, debridement and chondral abrasion, and osteochondral fragment removal after dislocation may have a role in the treatment of young patients with the early stages of coxarthrosis. Any patient with isolated posttraumatic arthritis of the hip who has a life expectancy greater than 30 years may be a candidate for hip arthrodesis. The ideal candidates for hip arthrodesis are only laborers younger than 35 years of age. Osteotomy of the hip for posttraumatic arthritis remains an appealing alternative for many patients because of the long-term failures of total hip arthroplasty. The clinical results of osteotomy are variable and do not match the results of a total hip arthroplasty. However, primary arthroplasty may fail, and revision arthroplasty is routinely more difficult and shorter lived than the primary operation.