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Reversal Of Hip Arthrodesis With Birmingham Hip Resurfacing  

 Kenneth Lo*, Michael Beverly**

* Imperial College of Science and Technology, London
**Ealing Hospital, Uxbridge Road,Middlesex  UB1 3HW

Address for Correspondence:

Kenneth Lo
15, Kingswood Road
Chiswick,W4 5EU


J.Orthopaedics 2007;4(3)e66


The reversal of hip arthrodesis with a Total Hip Arthroplasty has been well documented.  We describe the case of a reversal of an ankylosed hip in a 69-year-old man using a Birmingham Hip Resurfacing device.  No surgical complication occurred.  Six months following surgery, the patient exhibited good clinical function and remained satisfied with the outcome.  We conclude that metal-on-metal resurfacing arthroplasty represents a viable alternative for the reversal of hip arthrodesis.  To our knowledge, no similar cases have been reported in the literature to date

Case Report :

A sixty-nine-year-old retired man presented with difficulty with personal toilet function because of poor hip abduction.  He has a history of childhood TB infection treated on traction with bilateral ankylosis of the hips. He was able to work for 45 years as a London black cab taxi driver. On examination, no movement could be obtained in either hip.  There had been a left femoral fracture resulting in shortening of 10 cm on the affected side.

Radiographs show bilateral ankylosis of the hips (figure 1).  A posterior approach was used to explore the left hip.  Curved osteotomes were used to open the joint and a Birmingham Hip Resurfacing device was implanted routinely.  The acetabular cup was loose on impaction and the decision was taken to cement the component due to poor bone stock.

At 8 months follow-up the patient was asymptomatic with a painless range of movement of 30° of flexion, 30° of abduction, 10° of adduction, 30° of external rotation  and 60° of internal rotation (figure 2).  The patient was satisfied with the outcome of the operation and with an appropriate heel-raise, reported improved mobility and toilet function. 

Radiological studies

Figure 1. Pre-operative anteriorposterior radiograph of both hips showing bilateral arthrodesis.  

Figure 2 .Post operative anteriorposterior radiograph of the both hips, showing Birmingham Hip Resurfacing components in position

Discussion :

Several authors have reported on the reactivation of quiescent tuberculosis in Total hip Arthroplasty. [i] [ii] [iii]  Berbari reported only a minority of hip revision procedures had reactivation in patients who had received Tuberculosis prophylaxis.[iv]  Y.H. Kim 1 and Hardinge 2 reported no reactivation in their series of patients with over ten and twenty years of quiescent infection prior to arthroplasty respectively.  Pre- or post-operative anti-tuberculosis prophylaxis was deemed unnecessary in our patient.

Several studies have shown the long term efficacy of the Total Hip Arthroplasty in arthrodesis conversion.  Retrospective reviews conducted by Atul[v] and Schuh[vi] concluded that although the procedure had a favourable outcome, it was a technically demanding operation and had a higher risk of complications including, nerve palsies, heterotopic ossification and revision arthroplasty.

Although few long term comparisons between Hip Resurfacing Arthroplasty and full hip replacement have been reported, short term results for metal-on-metal hip resurfacing have been promising.  Hip resurfacing is becoming a more popular procedure in younger patients with primary osteoarthritis.[vii] [viii]

A series of retrospective studies in the UK have shown that Hip Resurfacing Arthroplasty in younger patient groups resulted in increased range of movement, enhanced stability, and greater preservation of femoral bone stock as well as better quality of life and activity scores.[ix], [x], [xi]  A retrospective study by Itayem[xii] evaluating the stability of Birmingham Hip Resurfacing in a small group of patients over 2 years showed a reduced incidence of migration of the components in Birmingham Hip Arthroplasty compared to Total Hip Arthroplasty.   

In our case, the decision to use a Birmingham Hip Resurfacing device instead of a Total Hip Replacement was based on several factors including the patient’s expectations, the anatomy and his atrophic musculature.  Although recovering a full range of movement was not expected, our objective was to restore functional use and maximum passive movement.  Wykman and Olsson[xiii] found that although patients with bilateral hip disease gained pain relief and improved walking speed after the first hip replacement, optimal speed and mobility were only achieved after both hips have been replaced.  To reduce instability and subsequent subluxation Hardinge[xiv] suggests obtaining firm tension of the abductors in a Total Hip replacement.  The abductors in our patient would have undergone considerable atrophy following long term ankylosis leading to a higher probability of dislocation.  The larger bearing surface in the Birmingham Hip Resurfacing device would theoretically reduce the risk of dislocation by offering greater stability compared to a Total Hip replacement.9   

In this case, the patient has retained adequate femoral neck anatomy and minimal bone stock loss following a tuberculosis hip ankylosis.  This allowed the Birmingham Hip Resurfacing device to be used effectively.  Provided the ankylosed joint can be opened with minimal bone stock loss, metal-on-metal resurfacing is a viable option for the reversal of a hip arthrodesis.

Reference :

  1. Kim YH, Han DY, Park BM. Total hip arthroplasty for tuberculous coxarthrosis. J Bone Joint Surg Am, 1987;69: 718-27. 

  2. Hardinge K, Cleary J, Charnley J. Low-friction arthroplasty for healed septic and tuberculous arthritis. J Bone Joint Surg Br, 1979;61: 144-7. 

  3. Dogra AS, Kulkarni SS, Bhosale PB. Total hip arthroplasty in healed tuberculous hip. J Postgrad Med 1995;41:114-6 

  4. Berbari EF, Hanssen AD, Duffy MC, Steckelberg JM, Osmon DR. Prosthetic joint infection due to Mycobacterium tuberculosis: a case series and review of the literature. Am J Orthop, 1998;27: 219-27.

  5. Atul B. Joshi, Ljubisa Markovic, Kevin Hardinge and John C.M. Murphy. Conversion of a Fused Hip to Total Hip Arthroplasty. . J Bone Joint Surg Am, 2002;84:1335-1341 

  6. Schuh A, Zeiler G, Werber S. Results and experiences of conversion of hip arthrodesis. Der Orthopade. 2005 Mar;34(3):218, 220-4.

  7. Laura Wyness, Luke Vale, Kirsty McCormack, Adrian Grant and Miriam Brazzelli The effectiveness of metal on metal hip resurfacing: a systematic review of the available evidence published before 2002 BMC Health Services Research 2004,4:39     doi:10.1186/1472-6963-4-39

  8. Daniel J, Pynsent PB, McMinn DJ. Metal-on-metal resurfacing of the hip in patients under the age of 55 years with osteoarthritis J Bone Joint Surg Br. 2004;86(2):177-84. 

  9. Loughead JM, Starks I, Chesney D, Matthews JN, McCaskie AW, Holland JP. Removal of acetabular bone in resurfacing arthroplasty of the hip: a comparison with hybrid total hip arthroplasty. J Bone Joint Surg Br. 2006 Jan;88(1):31-4. 

  10. Pollard TC, Baker RP, Eastaugh-Waring SJ, Bannister GC. Treatment of the young active patient with osteoarthritis of the hip: A five to seven year comparison of hybrid of Total hip arthroplasty and Metal-on-metal resurfacing. J Bone Joint Surg Br, 2006 May;88(5):592-600.

  11. Back DL, Dalziel R, Young D, Shimmin A. Early results of primary Birmingham hip resurfacings. An independent prospective study of the first 230 hips. J Bone Joint Surg Br, 2005 Mar;87(3):324- 9.

  12. Itayem R, Arndt A, Nistor L, McMinn D, Lundberg A. Stability of the Birmingham hip resurfacing arthroplasty at two years: A radiostereophotogrammetric analysis study. J Bone Joint Surg Br, 2005 Feb;87(2):158-62. 

  13. Wykman A, Olsson E. Walking ability after total hip replacement: a comparison of gait analysis in unilateral and bilateral cases. J Bone Joint Surg Br,1992;74-B:53–6.

  14. Hardinge K, Williams D, Etienne A, McKenzie D, Charnley J. Conversion of fused hips to low friction arthroplasty. J Bone Joint Surg Br, 1977;59(4):385-92. 


This is a peer reviewed paper 

Please cite as :Kenneth Lo :Reversal Of Hip Arthrodesis With Birmingham Hip Resurfacing  

J.Orthopaedics 2007;4(3)e6





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