Hip Fusion (Arthrodesis)
Hip Arthrodesis, or hip fusion, is now a relatively uncommon procedure. It is recommended for younger individuals with severe hip arthritis. This is because the alternative procedure, total hip replacement, will likely not last the entirety of the young individual’s life span due to prosthetic wear overtime. Hip arthrodesis is also recommended for those who have suffered from a significant infection of the hip joint and are therefore not a candidate for a total hip replacement. This procedure is typically used as a last resort if all other joint-preserving surgeries fail.
Hip arthrodesis is a salvage procedure. It is uncommon today because of major advances in total hip replacement. Total hip replacement, in contrast to hip arthrodesis, allows for movement of the hip joint and makes early rehabilitation after surgery easier.
Hip arthrodesis involves fusing the femur to the pelvis with plates and screws. It is performed with the leg in 25 degrees of flexion, 5 degrees of external rotation, and neutral abduction/adduction. This is the best position to ensure the ability to properly walk, lie down, and sit after surgery. This position also helps to minimize wear over time on nearby joints such as the lumbar spine and knee.
The recovery process after hip arthrodesis requires immobilization in a brace for an extended period of time after surgery. In general, recovery is much slower than after total hip replacement because the fusion needs to knit together, which takes several months. Post-surgical pain can be managed with pain medications such as NSAIDs as needed.
Complications from a hip arthrodesis are common and may include:
- Nonunion, or failure of the femur and pelvis to fuse
- Malunion, or improper fusion of the femur and pelvis
- Secondary arthritis in nearby joints such as the knee and lumbar spine
- Leg length discrepancy (uneven leg lengths)