Hip Resection Arthroplasty as Definitive Treatment: Indications, Outcomes, and Complications in Paraplegic and Non-paraplegic Patients.

Abstract

Background: Hip resection arthroplasty (HRA) serves as a salvage treatment option for various conditions affecting paraplegic patients, such as arthritis pain, infection, and spasticity. In non-paraplegic individuals, it is often utilized to manage complex infections. There exists a paucity of studies comparing outcomes between paraplegic and non-paraplegic patients undergoing HRA as definitive treatment. This study aimed to address this gap by analyzing the demographics, indications, outcomes, and complications in these two patient groups.

Methods: A retrospective analysis was conducted on 65 patients who underwent definitive HRA, divided into paraplegic (n = 25) and non-paraplegic (n = 40) groups. Data encompassed demographics, preoperative indications, postoperative complications, and outcomes.

Results: Paraplegic patients exhibited distinct characteristics compared to non-paraplegic counterparts, including younger age (P < 0.001), lower comorbidity scores (P = 0.013), fewer prior hip operations (P = 0.002), and a higher proportion of men (P < 0.001). Septic arthritis emerged as the primary indication for definitive HRA in both groups, constituting 64% (16 of 25) of paraplegic and 42.5% (17 of 40) of non-paraplegic cases. Non-paraplegic patients experienced a significant reduction in pain scores postoperatively (P < 0.001), with a notable improvement in mobility. Infection eradication rates were comparable between the two groups, with 82 and 92% success rates in paraplegic and non-paraplegic cases, respectively. However, paraplegic patients exhibited a higher reoperation rate (P = 0.041), while non-paraplegic individuals encountered increased major systemic complications (P = 0.052). Although the total complication rate was slightly higher in the non-paraplegic group (75 versus 56%), the difference was not statistically significant (P = 0.211).

Conclusion: Hip resection arthroplasty (HRA) was the definitive treatment that successfully treated infection in both groups. In the non-paraplegic group, it led to enhanced ambulatory capacity and decreased pain. Paraplegic patients experienced higher rates of reoperation, whereas non-paraplegic patients suffered from greater rates of major systemic complications. These findings provide valuable insights for clinicians considering HRA as a definitive treatment.