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KMID : 0386719920040010018
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Journal of the Korean Hip Society
1992 Volume.4 No. 1 p.18 ~ p.27
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Total Hip Replacement in Fused Hip (Comparison of end results of THR in spontaneously fused in malposition, surgically ankylosed and ankylosed by ankylosing spondylitis)
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김인
이승구/김성수/권순용/강용구/정인설/최문구/안동헌
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Abstract
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Since 1982, twenty-three ankylosed hips in nineteen patients were converted to total hip replacement, and followed them for more than 17/12 year, 25/12 on an average. Four patients unedrwent conversion arthroplasty of bilateral ankylosed
hips;
ankylosing spondylitis in 3 cases and tuberculous infection sequale in one case. The patient's age ranged from 33 to 62 years, an average of 49 years, There were six men and thitreen women. The duration of hip fusion to conversion to THR
ranged
from
two to forty-two years, an average of 21 years.
The causis of hip fusion were various; nine hips with tuberculosis, 3 hips with pyogenic arthritis and 2 hips with severe rheumatoid involvement were spontaneously ankylosed in malposition before. Another two hips with active
tuberoulosis
and one hip with pyogenic arthritis had previousy sundergone surgical hip fusion, and the remained six hips in 3 patients were ankylosed by ankylosing spondylitis.
The gait impairment due to painful malposition and leg length discrepancy, disabling pain on back or ipsilateral knee, and the patient's earnest desire to moblie hip were the predominant surgical indications.
Lateral Watson-Jones approach with or without trochanteric osteotomy in the hips and modefeed Gibson approach in thirteen hips were used. Twenty cementless THR were used As aresult of technical error, 6 cases of incorrect cup
inclination(less
than 40。 in 5 cases and more than 50。 in one case) and 3 cases of inadequate medialization of acetabular cup were noted, but free from another complications.
Post-operatively the pain on low-back and ipsilateral knee was significantly decreased and the range of hip motion was also improved upto 36% compared with unaffected hip. The power of hip abductor or flexors are increased as fair to
poor
in all cases. The average limb-length discrepancy was improved from preoperative 4.5cm true shortening to post-operative 1.4cm shortening in comparison with the other side. Three cases of calcar resorption, 2 cases of loosening
of
femoral component adn of reankylosis were noted at final follow-up.
Evaluation of overall results according tohip scoring method by d'Aubigne and Pwstel revealed that it was increased preoperative 8 points to postoperative 14 points.
As aresult, it was found that the conversion arthroplasty in fused hip could give useful relief of pain and improved function, thoughthe range of movement obtained was not as good as in primary replacement, and the least satisfactory results
obtained in patients with ankylosing spondylitis due to multifocal ankylosed joints as the diffuse soft tissue involvement.
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KEYWORD
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