Hip Arthrodesis and Associated Problems

I: General Aspects.- List of Abbreviations.- I. Historical Review.- II. Anatomy of the Hip Joint.- III. Biomechanics of Hip Arthrodesis and Internal Fixation: Kinetics and Elastometry.- 1 Introduction.- 2 Statics.- 2.1 Hip Joint and Lower Limb Skeleton.- 2.1.1 Standing on Both Legs.- 2.1.2 Standing on One Leg.- 2.2 Knee Joint.- 3 Kinetics.- 3.1 Introduction.- 3.2 Hip Joint and Lower Limb Skeleton.- 3.3 Pelvis and Lumbar Spine.- 3.3.1 Normal Conditions.- 3.3.2 Differences in the Coronal Plane.- 3.3.3 Differences in the Sagittal Plane.- 3.3.4 Knee Joint.- 3.3.5 The Contralateral Hip.- 4 Biomechanics of Individual Hip Arthrodeses.- 4.1 Introduction.- 4.2 Arthrodesis by Resection of the Joint Surfaces.- 4.3 Extra-articular Hip Arthrodeses.- 4.4 Hip Arthrodeses with Central Dislocation.- 4.5 Hip Arthrodesis with Pelvic Osteotomy.- 5 Biomechanics and Technique of Internal Fixation in Hip Arthrodesis.- 5.1 Introduction.- 5.2 Type I Hip Arthrodesis.- 5.2.1 Screw Fixation of the Iliofemoral Bridge Graft.- 5.2.2 Screw Fixation of the Proximal End of the Femur to the Pelvis.- 5.3 Type II Hip Arthrodesis.- 5.3.1 Buttress Plate.- 5.3.2 Compression Plate.- 5.4 Type III Hip Arthrodesis.- 5.5 Type IV Hip Arthrodesis.- 5.5.1 Correct Technique.- 5.5.2 Incorrect Technique.- 5.6 Hip Arthrodesis in the Presence of Infection.- 6 Elastometry.- 6.1 Introduction.- 6.2 Experimental Method.- 6.3 Results.- 6.3.1 Effects of Medial Displacement.- 6.3.2 Effects of Pretensioning of the Plate.- 6.3.3 Influence of Length of the Distal Screw.- 6.3.4 Hip Arthrodesis with Central Dislocation (Charnley).- 6.4 Evaluation of Experimental Results.- 6.5 Summary.- 7 Summary.- IV. General Indications for Hip Arthrodesis.- 1 Introduction.- 2 Diagnoses Leading to Hip Arthrodesis.- 3 General Considerations.- 3.1 Age.- 3.2 General Condition of Patient.- 3.3 Somatic Type.- 3.4 Sex.- 3.5 State of Joints Adjacent to the Arthrodesis.- 3.5.1 Lumbar Spine and Sacroiliac Joint.- 3.5.2 Ipsilateral Knee Joint.- 3.5.3 Contralateral Hip Joint.- 3.6 Occupation.- 3.7 Social Circumstances.- 3.8 Sport.- 3.9 Psychological Factors.- 4 Contraindications to Hip Arthrodesis.- 4.1 Relative Contraindications.- 4.2 Absolute Contraindications.- 5 Choice of Operation.- 6 Summary.- V. Operative Technique.- 1 Introduction.- 2 Preoperative Work-Up.- 2.1 Medical Examination.- 2.2 Radiological Examination.- 2.3 Orthopedic Investigation.- 3 Preparation for Operation.- 3.1 Anaesthesia.- 3.2 Positioning of the Patient.- 3.3 Draping.- 4 Operative Technique.- 4.1 Usual Operative Approach.- 4.2 Pelvic Osteotomy.- 4.3 Intertrochanteric Osteotomy.- 4.4 Wound Closure.- 5 Operative Technique: Particular Features of Different Arthrodesis Types.- 5.1 Type I Hip Arthrodesis.- 5.2 Type II Hip Arthrodesis.- 5.3 Type III Hip Arthrodesis.- 5.4 Type IV Hip Arthrodesis.- 5.5 Atypical Hip Arthrodeses.- 5.5.1 Hip Arthrodesis in the Presence of Infection.- 5.5.2 Arthrodesis of Girdlestone Hips or Similar Conditions.- 5.5.3 Arthrodesis of a High Dislocated Femoral Head.- 5.5.4 Hip Arthrodesis in Cases of Incomplete Painful Ankylosis of the Hip (Intertrochanteric Valgus Osteotomy).- 6 Corrective Osteotomies.- 6.1 Intertrochanteric Corrective Osteotomy.- 6.2 Supracondylar Corrective Osteotomy.- 6.2.1 Correction in Cases of Valgus Deformity.- 6.2.2 Correction in Cases of Varus Deformity.- 7 Summary.- VI. Summary of Part I (General Aspects).- II: Specific Problems and Case Material.- I. Evaluation of Case Material.- 1 Methods.- 2 Characteristics of Case Material.- 2.1 Sex.- 2.2 Age.- 2.3 Etiology.- 3 Types of Operation.- 3.1 Postoperative Course.- 3.1.1 Duration of Hospital Stay.- 3.1.2 Postoperative Cast Fixation.- 3.2 Intraoperative and Postoperative Complications.- 3.2.1 General Complications.- 3.2.2 Local Complications.- 3.2.3 Localised Operative Failures.- a) Pseudarthrosis.- b) Malposition.- c) Difference in Leg Length.- d) Nerve Damage.- e) Fatigue Fractures.- 3.3 Sociomedical Problems.- 3.3.1 Postoperative Fitness for Work.- 3.3.2 Disability.- 3.3.3 Independence of Patients with Hip Arthrodeses.- 3.4 Effect of Arthrodesis on the Contralateral Hip.- 3.5 Hip Arthrodesis and Back Complaints.- 3.6 Subjective Results.- II. Classification of Hip Arthrodeses by Indication.- 1 Hip Arthrodeses for Arthrosis of the Hip and Rheumatoid Arthritis.- 1.1 Arthrosis of the Hip.- 1.1.1 Introduction.- 1.1.2 Case Material.- 1.2 Rheumatoid Arthritis.- 1.2.1 Introduction.- 1.2.2 Case Material.- 2 Hip Arthrodeses in Cases of Hip Dysplasia.- 2.1 Introduction.- 2.2 Hip Arthrodeses for High Congenital Dislocation of the Hip.- 2.2.1 Increasing Leg Length by Hip Arthrodesis.- 2.2.2 Hip Arthrodesis for Arthrosis of the Secondary Acetabulum.- a) Hip Arthrodesis Following Angulation Osteotomy.- b) Hip Arthrodesis in the Presence of High Dislocation with Formation of a New Joint.- 2.3 Hip Arthrodeses for Varus Hip.- 3 Hip Arthrodeses for Post-traumatic Hip Disease.- 3.1 Introduction.- 3.2 Subsequent to Fractures of the Femoral Head.- 3.3 Posttraumatic Necrosis of the Femoral Head.- 3.4 Dislocation of the Hip with or without Fracture of the Acetabular Roof.- 3.5 Pelvic Fractures with Central Dislocation of the Hip.- 3.5.1 Case Material.- 3.6 Summary.- 4 Arthrodesis of Infected Hips.- 4.1 Introduction.- 4.2 Tuberculosis of the Hip.- 4.2.1 General Guide Lines.- 4.2.2 Case Material.- 4.3 Nontuberculitic Infections.- 4.3.1 Introduction.- 4.3.2 Case Material.- 5 Hip Arthrodesis for Necrosis of the Femoral Head.- 5.1 Introduction.- 5.2 Idiopathic Head Necrosis.- 5.2.1 Head Necrosis Alone.- 5.2.2 Head Necrosis with Subluxation of the Femoral Head.- 5.3 Femoral Head Necroses Subsequent to Orthopedic Operations.- 5.4 Post-traumatic Necrosis of the Head of the Femur.- 5.4.1 United Fracture.- 5.4.2 Pseudarthrosis Following Femoral Neck Fracture.- 5.4.3 Hip Arthrodesis as a Result of Inadequate or Incorrect Operative Technique.- 6 Hip Arthrodeses in Girdlestone Hip and Similar Conditions.- 6.1 Introduction.- 6.2 Girdlestone Hips.- 6.2.1 Subsequent to Prosthetic Replacement.- 6.2.2 Girdlestone Hip without Infection.- 6.2.3 Girdlestone Hip Following Clinically Eradicated Infection.- 6.3 Girdlestone-Hip-Like Conditions.- III. Hip Arthrodesis and Total Prosthesis.- 1 Introduction.- 2 Hip Arthrodesis Combined with Total Prosthesis on the Opposite Side.- 2.1 Statement of Problem.- 2.2 Case Material.- 2.3 Results.- 2.4 Case Material.- 3 Total Prosthesis Following Hip Arthrodesis.- 3.1 Introduction.- 3.2 Statement of Problem.- 3.2.1 Changes in the Musculature Following Hip Arthrodesis.- 3.2.2 Technical Difficulties at Operation.- 3.3 Indications.- 3.4 Case Material.- 3.5 Results.- 3.6 Case Material.- 4 Hip Arthrodesis Following Total Prosthesis.- 4.1 Introduction.- 4.2 Statement of Problem.- 4.2.1 Hip Arthrodesis Following Partial Prosthetic Replacement.- 4.2.2 Hip Arthrodesis Following Total Prosthesis.- 5 Summary.- IV. Complications.- 1 Introduction.- 2 Pseudarthrosis.- 2.1 Noninfected Pseudarthrosis.- 2.1.1 Stabilisation of the Pseudoarthrosis.- a) Compression Internal Fixation.- b) Bone Grafting.- 2.2 Infected Pseudoarthrosis.- 3 Malposition.- 4 Infections.- 4.1 Hematoma Considered as Potential Infection.- 4.2 Fresh Postoperative Infections.- 4.3 Quiescent Infection.- 5 Fatigue Fractures.- 5.1 Femoral Diaphyseal Fractures.- 5.1.1 Mechanism of Fatigue Fracture.- 5.1.2 Visualisation of Tension Lines Using Polarised Light.- 5.2 Femoral Neck fracture.- 5.3 Fractures Following Trauma.- 6 Dislocation of the Symphysis.- 7 Summary.- V. Summary of Part II (Specific Problems and Case Material).- References.