Total Hip Arthroplasty in Fused Hip

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: فارسی
مشاهده: 327

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OSAMED26_010

تاریخ نمایه سازی: 21 بهمن 1397

چکیده مقاله:

Hip arthrodesis remains a viable surgical technique in well selected patients, typicallythe young manual labourer with isolated unilateral hip disease. Despite this, itspopularity with patients and surgeons has decreased due to the evolution of hipreplacement, and is seldom chosen by young adult patients today. The surgeon is morelikely to encounter a patient who requests conversion to total hip replacement (THR).Common indications for the conversion of an arthrodesed hip to a THR include painarising from the lower back, ipsilateral knee or contralateral hip, a painful nonunion or malpositioned arthrodesis, planned ipsilateral knee replacement or fracturesaround the arthrodesis . Occasionally the patient will request conversion becauseof difficulty with activities of daily living, body image and perceived cosmesis. It isimportant that the origin of pain is accurately defined, and the functional demandsand expectations of the patient explored prior to conversion, in order for the patientto decide whether the anticipated risks and benefits are worthwhile.The original reason why the arthrodesis was performed should be sought. Ifthe arthrodesis was performed for or following infection, any history of delayedwound healing, wound drainage, sinus formation or antibiotics following previouship surgery should be actively excluded. In the presence of on-going infection, theauthors recommend a two-stage procedure is performed to ensure clearance ofinfection before any definitive THR.A clinical examination should be performed to define whether the hip is soundlyfused, in what position the hip has been arthrodesed, the amount of leg lengthdiscrepancy, (LLD) (which can be difficult to assess, particularly in the case of amalpositioned arthrodesis), and the integrity and function of the abductors.Satisfactory results can be achieved with a fully informed patient, who should bemade aware of the limitations of conversion, and the potential problems andcomplications that can be encountered Such as persistent pain, LLD, nerve and vesselinjury, persistent restriction in ROM, fracture, infection, dislocation and heterotopicossification. Ten year survivorship of between %74 and %96 has been demonstrated,and in the authors’ experience, complete resolution of the presenting complaintis achieved in a third of patients, with partial relief in the remainder. However theresults of conversion are inferior to those of primary and revision replacement.

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نویسندگان

Alireza Sadeghpour

Associate professor Tabriz University of Medical Sciences