Patients remain satisfied, report hip pain relief nearly 40 years after arthrodesis

Most patients reported walking without difficulty, but eventually developed back and knee pain.

Issue: June 2006

CHICAGO — Although many patients may develop adjacent joint pain after hip fusion, the majority report good daily function and satisfaction decades after the procedure.

Researchers conducting a near 40-year follow-up of 33 hip arthrodesis patients discovered that 75% developed back pain and 55% reported ipsilateral knee pain 20 years after hip fusion. Despite these findings, patients were pleased with the procedure and reported no significant difficulties with daily function.

“Hip fusion has relieved the hip of pain in all of our patients and, at the maximum time of our evaluations, all were satisfied with the results of the fusion,” said John M. Kirkos, MD, an orthopedist with the Aristotle University of Thessaloniki, Greece, during his presentation at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting. “Even though they are all informed about the potentials of total hip replacement, none of them requested this procedure to be reoperated.”

Kirkos and his colleagues identified 108 patients who received hip arthrodesis between 1965 and 1976. Of this group, they separated 33 patients (17 men and 16 women). These patients underwent fusion at a mean age of 27.4 and were re-evaluated at a mean age of 63 years.

Investigators radiographically assessed patients’ lumbo-sacral spine and knees. They also examined differences in limb length and signs of osteoarthritis. Patients also completed a questionnaire about their daily activities related to fusion.

Daily activities

The questionnaires revealed that many patients changed occupations (for example, from farming and manual labor), but had good long-term function following arthrodesis.

Of the 33 patients, 26 noted that they could sit in a hard-backed chair for 30 minutes. Similarly, 22 patients reported walking without any significant difficulty.

“Upon re-evaluation, all patients were satisfied with their fusions, and the preoperative pain, which was the main cause that the arthrodesis was conducted, was relieved and it did not reoccur,” Kirkos said. “All patients were able to walk and perform daily activities without significant difficulty.”

Investigators also discovered that fusion did not hamper patients’ function during sexual activity or childbirth.

“Twenty-seven patients claimed to have no problem with sexual intercourse, although five men reported difficulty mainly in abducting their hips,” Kirkos said. In assessing this area, one man reported multiple various problems. Postoperatively, two women in the study had children without hip difficulties.

Adjacent joint pain

While most patients reported pain relief in the fused hip, most had back and knee pain decades after the operation. Twenty-five patients said they had back pain, which developed at an average 24 years postop. The researchers discovered that patients with lower back pain had hips fused in 27.2° of flexion and 0.7° of abduction. On average, those without pain had hips fused in 4.8° more flexion and 4.6° greater abduction. “So the optimal position of the fused hip is around 30° to 35° of flexion and in 5° of abduction,” Kirkos said.

The researchers also discovered that 22 patients developed knee pain. More patients reported pain in the ipsilateral knee (18) than in the contralateral joint (4). These symptoms occurred after an average postop of 24.86 and 29.5 years, respectively. Only five patients reported pain in the contralateral hip.

For more information:
Kirkos JM, Papavasiliou KA, Sayegh F, et al. The long-term effects of the fused hip on the neighboring joints. #011. Presented at the American Academy of Orthopaedic Surgeons 73rd Annual Meeting. March 22-26, 2006. Chicago.