Brittain Ischiofemoral Arthrodesis for Tuberculosis of the Hip

Abstract

Seventy-six patients, forty-four of whom were children, underwent Brittain ischiofemoral arthrodesis for tuberculosis of the hip with irretrievable damage. The operation was satisfactory with regard to relief of pain, healing of the disease, and return of functional capacity. It was performed safely in the presence of actively discharging sinuses and was not restricted to cases with quiescent disease or to hips with fibrous ankylosis. Successful fusion occurred in 93.7 per cent of the adolescents and adults. Nine of the children required a second operation because of absorption of the grafts, and the success rate was 73.6 per cent according to the number of operations (88.6 per cent of the children's cases ultimately demonstrated fusion). The causes of failure were mainly technical and were avoidable. Sufficient (displacement of the osteotomy (more than one third the diameter of the femur) was associated with a lower incidence of graft fracture or absorption, or both, and hastened incorporation of the graft and fusion of the joint. The graft should be inserted firmly into the broad area of bone beneath the acetabulum. If inserted too high, it may enter the site of the active infection, and, if too low, a proper and firm engagement in the pelvic bone may not be obtained. Roentgenographic control is advisable, particularly in children or for severe deformity. Severe destruction of the joint with subluxation or upward migration did not predispose to absorption or fracture of the graft. Prolonged immobilization tended to produce stiffness of the knee in adults and mild deformity or ligamentous laxity of the knee in children. The Brittain arthrodesis did not limit growth of the limb significantly. Sciatic-nerve injury was not encountered in this series.