Hip Arthrodesis Using Surgical Hip Dislocation and Subtrochanteric Osteotomy

Abstract

Severe painful arthrosis in adolescent patients is a difficult dilemma. The surgical treatment options include total joint replacement or hip arthrodesis. As the longevity of hip replacements continues to improve, the option of hip replacement looks enticing. However, the long-term outcomes of joint replacements in adolescent patients still remain concerning. As such an argument can be made that in adolescent patients with severe painful degenerative joint disease of the hip, arthrodesis remains the preferred treatment option. Short-term problems with hip arthrodesis include nonunion, malalignment, and limb length discrepancy. Long-term problems include degenerative low back pain and ipsilateral knee pain as well as a difficult conversion to total hip arthroplasty. While the short-term problems can be minimized using the approach described in this chapter, the long-term problems of adjacent segment degenerative joint disease cannot and may in fact necessitate future conversion to total hip arthroplasty. Avoiding the use of complex plating techniques and minimizing trauma to the abductor musculature during the hip arthrodesis are important factors to consider for future total hip arthroplasty.