The short-term outcomes of hip arthrodesis in children and adolescents with end-stage hip disease
Keywords:end-stage hip arthritis, TB hip, hip arthrodesis, hip fusion, subtrochanteric osteotomy
Background: The management of end-stage hip disease in children and adolescents is a challenging clinical problem. While total hip replacement (THR) offers the benefit of improved mobility, this is offset by the risk of multiple revisions. Hip arthrodesis remains a salvage option to relieve pain and restore function at the cost of hip movement. This study aimed to determine the short- to medium-term outcome of hip arthrodesis in paediatric and adolescent patients in a developing world setting.
Methods: All children and adolescents under the age of 18 years who underwent hip arthrodesis between 2010 and 2014 were included in the study. Measurements included diagnosis, preoperative deformity, fusion position, fusion rate and functional outcomes. Our surgery involved transarticular compression screw fixation and subtrochanteric osteotomy. Postoperative skeletal traction maintained optimal limb position for two weeks, after which spica cast immobilisation was used.
Results: Nineteen patients (11 female) had hip fusions at a mean age of 12 years (range 5–18). The mean follow-up period was 5 years (range 1–8). Most cases were due to end-stage TB arthritis (12/19; 63%). Other causes were septic arthritis (3/19; 16%); neglected slipped capital femoral epiphysis (1/19; 5%); post-traumatic avascular necrosis (1/19; 5%); and idiopathic chondrolysis (2/19; 11%). Primary fusion was achieved in 68% (13/19) of cases. Six patients developed complications. Complications included adduction drift (3/19), failed fusion (3/19), screw malpositioning (1/19) and screw breakage (1/19). Eight reoperations were required in six patients. In two of these patients, one additional surgery had to be performed to achieve fusion or correct limb position. The mean fusion position was 31° (range 20 to 50) flexion, 2° (range 10 to −10) abduction, and 1° (range 10 to −10) external rotation. Mean leg length discrepancy was 1.8 cm (range 0 to 4.5) of shortening. All except one patient reported relief of hip pain and satisfaction with the procedure.
Conclusion: While hip arthrodesis is a technically challenging procedure, high fusion rates and reliable pain relief may be expected in these patients. However, complications should be anticipated, and reoperation may be required to achieve fusion and an optimal limb position.
Level of evidence: Level 4