anyone out there who has a fused hip (arthrodesis)?
Posted , 82 users are following.
Hi all am new to this site and am desperate to have communication with anyone who has had a similar operation. I had undiagnosed osteomyelitis as a baby and my hip was fused at about 1 years old. After spending nearly entire childhood on and off in hospital for long periods of time with full plaster casts up to underarms and frames, finally at the age of 12 last operation was done. I have just turned 52 and whilst up till the the last 3 years have managed pretty well. Married had 3 children and worked. Often got extra tired, but have always tried to keep up with others.
In the last 3 years things have been VERY difficult and scary. Endless tests,lack of understanding and neurological type problems, spine issues and still more tests and so far no resolution. I am pretty sure all the problems stem from having a long standing fused hip and it has taken it's toll on the rest of my body, especially spine.
I feel so alone with my problem because I have NEVER met or communicated with anyone who has a fused hip. I have gone on various sites, googled endlessly, but cannot find a single person who has same problem. It would be such a comfort to communicate with someone else with same situation or some support group. Even the medical professionals seem to lack understanding on fused hip and I feel like an alien because of this. So PLEASE, if you have a fused hip,especially one that has lasted this long I would love to here from you and hopefully we can change things for ourselves and others for the better.
8 likes, 234 replies
Knob54 debra57
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I am 18 I broke my hip doing motocross when I was 12 and when I was 14-15 my hip collapsed and I was on a waiting list for surgery for around a year and because of that I missed a whole year of school, even if I went on crutches I'd be in excruciating pain that night. I had my hip fused and I've been pretty good since. I put on alot of weight but I figured out that I could still somewhat bike and skate and walk just enough to keep up with my mates. In the last 7 ish months of being 18 I've lost alot of fat but I'm finding it hard to gain muscle on that half of my lower body and back. I have quite a bit of back pain when I'm active as well. Any ideas with what I could do to strengthen those parts of my body would be very appreciated
jusblaze debra57
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anthony20820 jusblaze
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I’m 51 years old and had my left hip fused at
16 years old,given a preference now I would go for plastic hip to give more mobility.
Having said that I can swim,sit and cycle still
I get back pain and knee pain but I consider myself quite fit except it’s uncomfortable walking up slopes I have considered having the hip unfused but I worry after 35 years I’m not sure if it would give me a better quality of life .
jeff54470 debra57
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Don't know if anyone is still active on this subject. Just found it. I had a hip fusion done in 1971. Was 10 years old. Congenital hip displacement. Was told I would be in a wheelchair by 13 if the hip wasn't fused. I am now 57. Right knee is almost bone on bone. Right leg is a inch shorter. Drop foot on the right foot and the foot is turning in. Ankle has arthritis. Back issues somewhat. I go to the shoe maker to have lifts put on the right shoe. I wear shoes with Velcro closures to close with a 18 inch pliers so I can reach. Some times I wear tie shoes someone has to tie the right one. Was told that no orthopedic surgeon worth his weight would take down my fusion. Would be nice to ride a bike or run like the wind again. Just a wish.
Jeff45023 jeff54470
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who told you an ortho surgeon would not take down your fusion? Or an orthopedic surgeon? I keep hearing people say that, but they never tell anyone where they heard that. I've been told by two separate orthopedic doctors over the last 5 years that hip fusion takedowns are definitely doable. Dr. Schwaab from Froedert in Milwaukee told me it's possible, and Dr. Jacobson from Rush in Chicago also said it's possible. I could have had mine done but I did not do it yet. I'm younger than you, and still in good shape so i don't feel the need yet. Here, I'll give you the name of a doctor that does hip fusion take downs, hip reconstruction surgery, etc. Call them! Yes, I know, it's alot of work just and a pain in the a**, but I traveled all the way to downtown Chicago a couple of years ago to talk to these doctors. They said 'yes we can definitely do it, tell us when'. And then please update us if you do call them. Thank you! Brett Levine, Midwest Orthopaedics at Rush, 1611 W. Harrison Street, Suite 400, Chiciago, IL. Their number is 312 432 2344.
alisonpalk Jeff45023
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Jeff45023 jeff54470
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What Alison wrote all seems very accurate. I should have offered some more details. I too think in general, an average 'orthopedic surgeon' probably would not do a hip fusion takedown to a replacement. But in my experiences, while the average ortho surgeon may not do it, a well connected ortho surgeon should know somebody in their network/profession that specializes in hip reconstruction. I first visited an ortho surgeon out in the suburbs, he definitely wouldn't do that type of operation, but he recommended rush ortho group in chicago. So then i went to see this Dr. Jacobs at Rush. That took half a day to go see him. And then, after all of that, he told me he also wouldn't do that type of operation, but, that another surgeon in his group, Brett Levine, would do it. That he specializes in hip reconstruction. So yes, you probably can't just go anywhere and expect an ortho surgeon to do it, but I do think it's very possible with enough effort, to find a surgeon who has enough expertise to do these trickier takedowns/replacements. And yes, even when you find a surgeon who could do it, they are going to give you all kinds of warnings. They'll tell you it's higher risk, they'll tell you that the risk of dislocation after the operation is higher, that the muscle mass surrounding the hip is a concern, etc. I believe that if you're in bad enough shape from years of a hip fusion, that the risks are worth it. In other words, life is just miserable, you're in constant pain, you can barely move, etc. I'm just not at that point yet.
anthony20820 alisonpalk
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Do you know the names of the surgeons in the U.K.
mine isn’t too bad but I’m conscious it will deteriorate as I get older I’m 51 had the surgery after a bad motorcycle accident at 16 years old
Regards Anthony
alisonpalk anthony20820
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I'll try to find out for you.
anthony20820 alisonpalk
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alisonpalk anthony20820
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Here's one:
Mr Philip Stott, Orthopaedic Surgeon
MB, BS, FRCS (Tr. & Orth.), MRCS, DPhil
Brighton and Sussex University Hospitals
NHS Trust
Royal Sussex County Hospital
Eastern Road
Brighton
East Sussex
GB
BN2 5BE
anthony20820 alisonpalk
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anthony20820 Jeff45023
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I found this article might be of interest
HIP FUSION TAKEDOWN: WHY AND HOW
D.J. Berry
Published Online:21 Feb 2018
About
The main challenges in hip arthrodesis takedown include the decision to perform fusion takedown and the technical difficulties of doing so. In addition to the functional disadvantages of hip fusion, the long-term effects of hip arthrodesis include low back pain and in some cases ipsilateral knee pain. Indications for fusion conversion to THA include arthrodesis malposition, pseudoarthrosis, and ipsilateral knee, low back, contralateral hip problems, and functional disadvantages of ipsilateral hip fusion. When deciding whether or not to take down a fusion, consider the severity of the current problem, risks of takedown and likely benefits of takedown. Best results of fusion takedown occur if abductor function is likely to be present. If the abductors are not likely to function well, dearthrodesis may still help, but the patient will have a profound Trendelenburg or Duchenne gait and risk of hip instability will be higher. Abductor assessment can be performed by determining if the abductors contract on physical exam and determining if the previous form of fusion spared the abductors and greater trochanter. EMG and MRI also can be performed to assess the abductors, but value in this setting is unproven. Before dearthrodesis establish realistic expectations: most patients will gain hip motion—but not normal motion, most will see improvement in back/knee pain, but many will become cane-dependent for life.
The main technical issues to overcome involve exposure, femoral neck osteotomy, acetabular preparation, and femoral fixation. Exposure can be conventional posterior, anterolateral or direct anterior with an in situ femoral neck cut. In complex cases, a transtrochanteric approach is often helpful. The in situ neck cut is facilitated by fluoroscopy or intra-operative radiograph to make sure the cut is at the correct level and at the correct angle. Be careful not to angle into the pelvis with the cut. Acetabular preparation is more complex because anatomic landmarks often are absent or distorted. Try to find landmarks including ischium, ilium, teardrop, and fovea. Confirm location with fluoroscopy as reaming commences and during reaming. Depth of reaming can be improved by using the fovea (if present) and teardrop on fluoroscopy. Cup fixation is usually an uncemented cup, fixed with multiple screws because bone quality typically is compromised. Femoral fixation is at the surgeon's discretion, recognizing the proximal bone may be distorted in some cases. Post-operative management includes protected weight bearing as needed and heterotopic bone prophylaxis in selected patients.
anthony20820 debra57
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anthony20820 debra57
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Published Online:21 Feb 2018
About
Hip fusion is an uncommon procedure. Hip fusion takedown, therefore, is equally an uncommon procedure. What is of considerable interest is that the results, which I achieved in 20 cases in a paper published in 1987 are considerably superior to the results, which I am achieving today. This suggests that no simple case is now fused. It also equally suggests that there is little sense in looking at literature more than 10 or 15 years old on fusion takedowns as the two conditions are likely completely different.
Most patients do not like a hip fusion. There are long-term problems with low back pain, ipsilateral global instability and contralateral patellofemoral osteoarthritis. A stiff hip produces a poor quality of life, especially in a tall person. The main problem in doing a hip fusion takedown is the condition of the abductors muscles. If fused before growth was complete, there may be pelvic hypoplasia. If the pelvis is small, the glutei will also be small. Sometimes, the glutei may have undergone fatty degeneration. This can be assessed by means of an MRI. If the abductors were damaged during fusion, a limp may persist. Other problems are that leg lengthening is difficult to achieve any longstanding hip fusion. Lengthening of 1–2 cm is usually about all that can safely be achieved. If the hip was fused in childhood, there is likely to be femoral hypoplasia. There is also likely absence of proximal cancellous bone and the proximal femur is a thin brittle cortical tube. The greater trochanter should not be detached as it is difficult to obtain union under such circumstances. The approach, which I prefer for a fusion takedown is an anterior Smith Peterson. The glutei are slid off the pelvis sidewall and then the upper part of the fusion can be exposed, blunt Hohmans can then be passed around the femoral neck prior to transection. Obviously, if any AO cobra plate has been used for a fusion, a trochanteric osteotomy may be required to preserve any glutei left. Old hardware can be removed either concurrently or as an interval procedure. In 1986, I published the results of 20 cases with a five to 40-year fusion time (mean 19). I used a variety of implants. Flexion was achieved to 90 degrees at 12 months in about 88% of people. Seventy-five percent ceased to limp by year one, although the elderly limp when tired. One patient was dissatisfied with the procedure. One was revised for pain.
I have reviewed the cases done in the last 20 years. These were 28 cases, two bilateral. Seven were spontaneous fusions. Twenty-one were formal hip fusions. One was an AO fusion with a cobra plate. There were various intra-operative complications including two calcar cracks, which were wired, three femoral shaft fractures, which necessitated the use of long stems. There was one drop foot, which recovered. At review, a limp was absent in 20%, mild in 12% and severe, i.e. Trendelenburg positive in 68%. Harris hip scores were excellent in 28%, good in 32%, fair in 16% and poor in 24%. Four patients only, however, continued to use canes. The eventual range of movement was good. In 80%, more than 90 degrees of flexion was obtained, but it took up to two years to obtain maximum flexion. In 12%, the range of motion was poor at being 50 degrees to 85 degrees. The range of motion was poor, i.e. less than 45 degrees in one bilateral case of athrogryposis. This was a stiff arthrogrypotic. Further surgery is required in several cases. An ipsilateral total knee replacement and one a supracondylar femoral osteotomy. One cup loosened and was revised at seven years and one liner was exchanged at ten years.
christine24271 anthony20820
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now this is such a useful post. so much better than me rambling on. about experiences thankyou for posting this. i am going to copy and paste it print it out and give it a real good read. thankyou.