Journal of clinical orthopaedics and trauma · 2026
Surgical technique, outcomes and complications of conversion total hip arthroplasty in ankylosed hip operated through the posterior approach: A retrospective cohort study.
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Tripathy Sujit Kumar, Khan Shahnawaz, Bhagat Ankit, Varghese Paulson, Pradhan Siddharth, Jain Mantu
Аннотация
BACKGROUND: Conversion total hip arthroplasty (THA) in ankylosed hips is technically challenging because of distorted anatomy, soft-tissue contractures, and compromised bone quality. Flexion, abduction, and external rotation deformities, common in inflammatory conditions, further restrict visualization of the femoral neck and pubofemoral arch when using the posterior approach. This study outlines technical modifications to overcome these challenges and reports the clinical and radiological outcomes of conversion THA performed through a posterior approach in patients with ankylosed hips.
METHODS: In this retrospective study, patients who underwent conversion THA for bony ankylosed hips from January 2014 to June 2022 were analysed. Forty-five patients (70 hips) with ≥2 years of follow-up were included. Preoperative and postoperative clinical parameters (Harris Hip Score [HHS], range of motion [ROM]) and radiographs were evaluated. All procedures were performed by a single surgeon using a posterior approach with specific technical modifications to improve exposure. Statistical comparisons were made using paired t-tests.
RESULTS: The cohort included 34 males and 11 females, with a mean age of 38.7 years and mean follow-up of 7.5 years. Ankylosis was most commonly due to ankylosing spondylitis (48 hips). Mean operative time was 96 min and mean blood loss 349 mL. The HHS improved significantly from 22.4 preoperatively to 85.0 at final follow-up (p < 0.001). Hip flexion improved to a mean of 94.8°, with meaningful gains in extension and rotation. All implants remained radiologically stable, with two stems showing minor non-progressive subsidence. Complications included one transient sciatic nerve palsy, one dislocation requiring revision and four Brooker grade II heterotopic ossification without any functional restriction.
CONCLUSION: Conversion THA through a single posterior approach provides reliable functional recovery and implant stability in fused hips. With appropriate technical modifications and careful soft-tissue handling, excellent outcomes can be achieved with a low complication rate.
METHODS: In this retrospective study, patients who underwent conversion THA for bony ankylosed hips from January 2014 to June 2022 were analysed. Forty-five patients (70 hips) with ≥2 years of follow-up were included. Preoperative and postoperative clinical parameters (Harris Hip Score [HHS], range of motion [ROM]) and radiographs were evaluated. All procedures were performed by a single surgeon using a posterior approach with specific technical modifications to improve exposure. Statistical comparisons were made using paired t-tests.
RESULTS: The cohort included 34 males and 11 females, with a mean age of 38.7 years and mean follow-up of 7.5 years. Ankylosis was most commonly due to ankylosing spondylitis (48 hips). Mean operative time was 96 min and mean blood loss 349 mL. The HHS improved significantly from 22.4 preoperatively to 85.0 at final follow-up (p < 0.001). Hip flexion improved to a mean of 94.8°, with meaningful gains in extension and rotation. All implants remained radiologically stable, with two stems showing minor non-progressive subsidence. Complications included one transient sciatic nerve palsy, one dislocation requiring revision and four Brooker grade II heterotopic ossification without any functional restriction.
CONCLUSION: Conversion THA through a single posterior approach provides reliable functional recovery and implant stability in fused hips. With appropriate technical modifications and careful soft-tissue handling, excellent outcomes can be achieved with a low complication rate.