Hip arthrodesis. A long-term follow-up.

Area of Science:

• Orthopedic Surgery
• Musculoskeletal Health
• Reconstructive Surgery

Background:

• Arthrodesis, a surgical procedure to fuse joints, has been performed for decades to treat severe joint damage.
• The long-term consequences of hip arthrodesis on adjacent joints and spinal health remain a significant clinical concern.
• Understanding the late sequelae is crucial for patient counseling and optimizing surgical techniques.

Purpose of the Study:

• To evaluate the long-term outcomes of hip arthrodesis performed 17-50 years prior.
• To assess the incidence and characteristics of ipsilateral knee pain, back pain, and contralateral hip pain.
• To investigate the impact of hip fusion position on adjacent joint degeneration and pain.

Main Methods:

• Retrospective study of 28 patients with a history of hip arthrodesis (average 35 years post-op).
• Clinical assessment included hip and knee ratings, pain evaluation, and functional capacity (walking, sitting).
• Radiographic evaluation included lumbar spine and standing knee/hip radiographs to assess laxity and degenerative changes.

Main Results:

• Approximately 60% of patients reported ipsilateral knee pain (average onset 23 years post-op) and back pain (average onset 25 years post-op).
• 25% experienced contralateral hip pain (average onset 20 years post-op).
• Hip fusion in abduction correlated with increased ipsilateral knee pain, back pain, and knee degeneration compared to neutral or adduction fusion.

Conclusions:

• Long-term hip arthrodesis is associated with a high prevalence of ipsilateral knee and back pain, and moderate contralateral hip pain.
• Despite pain, most patients retain functional capacity for walking and sitting.
• Surgical positioning during hip arthrodesis may influence the development of secondary pain and degeneration in adjacent joints.