Arthrodesis of the Hip

Review of 371 Cases

¹ Section of Orthopedic Surgery, Mayo Clinic and Mayo Foundation, Rochester

An analysis has been presented of 371 patients who had arthrodesis of the hip at the Mayo Clinic during the years 1914 through 1959.

Whereas thirty years ago most hip fusions were done because of tuberculosis of the hip, the majority now are done for post-traumatic conditions.

Arthrodesis of the hip can be expected to be successful in approximately 90 per cent of the patients if modern surgical techniques and principles are followed, including: (1) stimulation of osteogenesis by the use of massive bone grafts, (2) internal as well as external fixation of the head or upper end of the femur to the pelvis, (3) osteotomy of the femur just below the site of its fixation to the pelvis, thereby removing temporarily the stress caused by the great leverage exerted by the lower extremity, and (4) adequate and sufficiently prolonged external fixation.

Although the numbers of arthrodeses in the different disease categories in this series are too small to be significant, there are trends which are of interest. Ischiofemoral arthrodesis and conventional fusions (intra-articular or extra-articular arthrodeses or a combination of the two) seemed to result in a lower rate of fusion.

Subtrochanteric or intertrochanteric osteotomy, internal fixation of the femoral head to the pelvis, or both of these procedures, when combined with a conventional arthrodesis, seemed to increase the rate of fusion.

From the data available, there is little, if any, indication that the disease or condition requiring fusion influenced the fusion rate. The technique of fusion appeared to be the most important factor.

Arthrodesis, in our opinion, is the procedure of choice for most active young and middle-aged adults requiring an extensive reconstructive surgical procedure for one hip.

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