Conversion of Fused Hip to Total Hip Arthroplasty: Long-Term Clinical and Radiological Outcomes

Guido Grappiolo 1 , Carmine F Bruno 1 , Mattia Loppini 2 , Michele Mercurio 3 , Davide Castioni 3 , Giorgio Gasparini 3 , Olimpio Galasso 3

  1. Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy.
  2. Hip Diseases and Joint Replacement Surgery Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
  3. Department of Orthopedic and Trauma Surgery, “Magna Græcia” University, “Mater Domini” University Hospital, Catanzaro, Italy.


Background: Despite promising results at the mid-term followup, several aspects of conversion of the fused hip to total hip arthroplasty (THA) remain controversial. The aim of this study was to evaluate clinical and radiological outcomes with a minimum 5-year followup in patients who underwent conversion of the fused hip to THA.

Methods: Fifty-seven patients (59 hips) were evaluated. The Harris Hip Score (HHS), range of motion (ROM), and the Visual Analogue Scale (VAS) were used to assess hip function and low back pain. Subjective satisfaction with surgery and the presence of the Trendelenburg sign was also evaluated. Radiological assessment was performed pre- and postoperatively to evaluate loosening and heterotopic ossification (HO).

Results: After a mean followup of 13.0 ± 6.2 years, HHS and VAS significantly improved from 46.0 ± 16.7 to 80.8 ± 18.8 and from 4.4 ± 1.5 to 2.1 ± 1.4 (both P < .001), respectively. Twenty-three patients (40.4%) had a positive Trendelenburg sign, and HOs were found in 29 cases (49.1%). An overall 29.8% complication rate was noted. Smoking habits and rheumatoid arthritis were predictive of Trendelenburg sign (P = .046 and P = .038, respectively). Implant survival rate as the end point was 98.7 ± 1.3% at 5 years, 92.4 ± 3.3% at 10 years, 82.1 ± 5.7% at 15 years, and 73.4 ± 8.0% at 20 and 25 years. A worse cumulative implant survival rate was noted in patients who underwent previous hip surgery, defined as any hip operation before fusion (P = .005).

Conclusion: Conversion of the fused hip to hip arthroplasty provides high levels of hip functionality and satisfaction with surgery at long-term followup. An implant survival rate higher than 70% can be expected 25 years postoperatively.

Keywords: conversion hip arthroplasty; fused hip; implant survivorship; low back pain; total hip arthroplasty; trendelenburg.

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