Arthrodesis of the hip joint using an external fixator

Subtrocantheric nonunion following fracture of an arthrodesed hip: a case report

In recent years in the era of successful of total hip replacement, hip arthrodesis is rarely performed. The anatomy and biomechanics of an arthrodesed hip is altered, thus influencing the treatments strategies in case of fracture or nonunions. This case report describes the management and therapeutic solution for the treatment of subtrochanteric nonunion in a patient with hip arthrodesis. Satisfactory outcomes were finally obtained after a double surgical procedure.

Risk assessment and usefulness of musculocutaneous flap transposition for recurrent septic arthritis of the hip in adults

PURPOSE

Septic arthritis of the hip joint in adults often progresses to recurrent infections that require repeated surgeries for treatment. The purpose of the present study was to assess the risk of a recalcitrant hip infection and the usefulness of musculocutaneous flap transposition.

METHODS

15 adult patients who underwent surgeries for the treatment of hip infections were retrospectively analysed. Patients who recovered from infection by undergoing arthroscopy, open irrigation, debridement, continuous irrigation, resection arthroplasty, and/or the placement of antibiotic-loaded acrylic cement were classified into Group A (n = 10). Patients who showed residual infection after multiple surgeries and ultimately recovered after undergoing musculocutaneous flap transposition were classified into Group B (n = 5). The age at onset, sex, incidence of multi-drug-resistant organisms, incidence of infection at other sites, compromising factors, peak preoperative C-reactive protein level, and period from onset to initial surgery were compared between groups.

RESULTS

There was a statistically significant difference in the period from onset to initial surgery (p = 0.024). The infections remained chronic after multiple surgeries in most patients who had complications and/or a poor general or local condition. All of the patients recovered after musculocutaneous flap transposition without the need for additional surgery and did not experience recurrence during the follow-up period in Group B.

CONCLUSIONS

Delayed diagnosis and/or treatment and compromised host caused recurrent septic arthritis of the hip in adults. Musculocutaneous flap transposition may be a useful method for the treatment of recalcitrant hip infection.

Determinants of ambulatory ability after hip fracture surgery in Japan and the USA

We examined the relationship of the length of stay and the day of initiating partial weight bearing to patients' level of ambulatory ability at 3 months after hip fracture surgery in Japan and the USA. The participants were patients aged > or = 65 years who had undergone hip fracture surgery between August 2005 and September 2007. The data were collected from three hospitals in Japan and two hospitals in the USA. The participants received questionnaires pertaining to patient health outcomes after discharge. One-hundred-and-forty-nine patients in Japan and 88 patients in the USA completed the questionnaire. In Japan, the length of stay before surgery was longer and partial weight bearing after surgery was initiated later, compared to the USA. This independently predicted a lower level of ambulatory ability at 3 months after surgery. Assessing the reasons for delaying surgery and partial weight bearing is important in Japan. Encouraging ambulation with weight bearing at the earliest possible time is essential for patients to maintain their ambulatory ability after hip fracture surgery. Prospective studies using a large sample and/or intervention studies are required to determine the causal effect on ambulatory ability.

Intertrochanteric fracture of an arthrodesed hip

We report the case of a 74-year-old woman who sustained an intertrochanteric fracture of the femoral neck in a previously arthrodesed hip. The hip arthrodesis had been performed 53 years earlier to treat septic arthritis. The fracture was treated successfully using a double-plating technique with 4.5 mm titanium reconstruction plates.

Femoral neck fracture in an arthrodesed hip treated by a supracondylar intramedullary locked nail

We describe a case of a femoral neck fracture occurring 51 years after a hip arthrodesis. This rare lesion in an obese woman was treated with a straight supracondylar nail with proximal and distal locking inserted retrograde from the subtrochanteric area into the ileum. Full weight bearing was achieved within 1 week postoperatively, and union was present 3 months following the operation.

Hip arthrodesis: a procedure for the new millennium?

Advanced hip arthrosis in the young patient represents a difficult problem. Using currently available techniques, total hip arthroplasty (THA) in this patient population likely would result in multiple revision surgeries, usually at the expense of bone in the proximal femur and acetabulum. For noninflammatory, monoarticular hip arthritis, arthrodesis remains an excellent reconstruction option. Arthrodesis can provide pain relief and return to function in the majority of patients indicated for the procedure. Current techniques provide acceptable fusion rates. If possible, techniques that protect the abductor mechanism and limit deformity of the pelvis should be used. Patient education is an important part of the treatment process. The position of the limb is important to early satisfaction and durability of the fusion. Long-term difficulties after hip fusion are related to pain in contiguous joints. Conversion arthroplasty, if necessary, can result in favorable outcomes. Familiarity with the techniques and outcomes of hip arthrodesis are important for the hip surgeon to understand.