[Total endoprosthesis replacement after hip joint arthrodesis].
OBJECTIVE
To evaluate mid-term results of conversion of arthrodesis to total hip replacement in terms of X-ray findings and benefits for the patient.


METHODS
Ten patients who had undergone hip joint arthrodesis were clinically examined and X-rayed and the findings evaluated. The most common indications for arthrodesis were posttraumatic lesions or the sequelae of a dysplastic hip joint, Perthes disease and inflammatory hip arthritis. The average age was 24.6 years (range, 15-37) at the first operation (arthrodesis) and 42.5 years (range, 30-61) at the second operation (hip arthroplasty). The average follow-up was 9.3 years (range, 1-16). Patients with true ankylosis of the hip joint were not included.


METHODS
The patients were clinically examined for the range of motion, which was evaluated by Harris hip scores and X-ray findings.


RESULTS
All eight patients who underwent total hip replacement due to persistent pain in the lumbosacral region experienced pain relief or its absence. This also applied to the patients whose X-ray films showed signs of spondylarthritis. The Harris hip scores showed that six patients were able to walk to longer distances without any support. No radiographic evidence of acetabular component loosening was found. One patient had to undergo reimplantation of the femoral component because of aseptic loosening. In the early postoperative period, one dislocation of the prosthesis and one sciatic nerve injury resulting in transient paresis of the peroneal nerve were recorded. None of the complications required repeat surgery. All patients reported that they would undergo the procedure again despite an increased risk associated with this procedure.


CONCLUSIONS
Our results are in agreement with similar findings in this field. We did not find an increase in failed hip arthroplasty in older patients. The X-ray findings were very satisfactory, particularly those concerning the acetabular component. Patients who had true ankylosis of the hip joint were not included in the study. The average range of motion achieved in our patients corresponds to that reported in the literature.


CONCLUSIONS
Conversion of hip arthrodesis to total hip replacement is not a frequent surgical procedure. It is associated with a higher degree of risk because of changed anatomy due to previous surgical interventions in that region. Motion restoration in the hip joint results in reducing low back pain and, consequently, improving the quality of life. All evaluated patients would be willing to undergo the operation again.
Hajný
P
P
Ortopedická klinika IPVZ a 1. LF UK, FN Na Bulovce, Praha.
Kolman
J
J
D000293:Adolescent; D000328:Adult; D001174:Arthrodesis; D019644:Arthroplasty, Replacement, Hip; D005500:Follow-Up Studies; D006621:Hip Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D011859:Radiography; D012086:Reoperation