The Contemporary Role for Hip Arthrodesis and Hip Replacement in Adolescents

Abstract

Abstract: Hip arthrodesis and arthroplasty are historically proven options for end-stage arthritis in the young patient. Currently, patient and surgeon related factors influence choice of treatment. Arthrodesis relieves arthritic pain and enables modified function with expected eventual transition to arthroplasty. Conversion arthroplasty following arthrodesis provides good outcome with significant functional gain. Primary total hip arthroplasty for young patients is increasingly accepted due to improvements and consistency of implantation and more patient-expected natural levels of function. Advances in arthroplasty implants have increased component survivorship, but studies are still needed to determine outcomes using modern implants. Data supporting arthrodesis or arthroplasty for young patients with end-stage hip arthritis requires further study. This article summarizes the dilemma, provides current data in order to help guide decision-making. Key Concepts: •End-stage hip arthritis in the young patient is an extremely challenging problem and one where long-term treatment options are limited.•Hip arthrodesis can provide decades of pain relief for adolescents with unilateral hip arthrosis who may be a poor candidate (obesity, medical or social co-morbidities) for hip replacement. Later back and knee pain limits long term outcome.•Hip arthroplasty is a good option for patients with the bilateral hip arthritis (e.g., sickle cell disease, chemotherapy- induced necrosis, inflammatory arthropathies); the desire for initial near normal hip motion is tempered by the uncertainty of implant survival and the need for multiple joint revisions.