Hip Arthrodesis and Total Prosthesis

Abstract

Of the three most frequent hip operations (IO, HA and TP), TP has become the commonest in the last 7 years. Some orthopaedic and general surgeons were, or still are, of the opinion that TP is now the operation of choice for all forms of hip arthrosis and have rejected IO almost completely and HA totally. TP certainly has many advantages (freedom from pain, very good range of motion, no difficulties with adaptation, simple postoperative management), but the experience of approximately 10 years to date is inadequate and the increasing occurrence of problems to which solutions have not yet been found (loosening of anchorage, signs of wear, secondary trophic changes) is such that wholesale acceptance of the technique and rejection of other techniques is not yet justifiable. Early or late TP infections usually have more serious consequences than those occurring following IO or HA (Boitzy and Zimmermann; Charnley and Eftekhar). Continuing improvement in the design of artificial joints, simplification of operative techniques and measures to prevent infection (prophylactic vaccination, sterile operating boxes) justify the hopes that the problems may one day be solved but until then, caution should be exercised in the choice of indications. A certain optimism is justified, but euphoria is not.