Pseudarthrosis of the hip joint.

The problem of disabling osteoarthritis of the hip is difficult when only one hip is involved, far more so when both are affected. The orthopaedic surgeon is largely concerned with the improvement of function, and with operations of choice rather than of necessity ; but in cases of severe osteoarthritis of the hip, with its progressive interference in work, recreation and sleep, any relief that he can give by operation becomes a matter of necessity. The operations available include arthrodesis, arthroplasty, pseudarthrosis, osteotomy (McMurray 1935) and denervation of the joint (Tavernier and Godinot 1945). It is the object of this article to describe one of these methods-pseudarthrosis-and to report on the long-term results. It is vell that every surgeon should appreciate the facts about each of these operations-its magnitude, reliability, capacity to restore activity and function of the hip, its demands upon other joints (particularly those of the lumbar spine) and the duration of the relief that can be expected. In the past, the operation most frequently employed for the relief of osteoarthritis of the hip has been arthrodesis. This is often successful in relieving pain and securing stability at the expense of movement. But the hip was designed to move ; and movement in or near the hip is desirable for both sitting and walking. When the hip is fused, excessive strain is thrown on the lumbar spine, which in elderly persons is frequently itself the site of degenerative changes. Cup arthroplasty of the hip joint, a severe operation designed to restore movement and preserve stability, is still under trial. It is possible that further advances may place it in the category of reliable operations with lasting benefit, but evidence is, as yet, incomplete. Osteotomy of the type advocated by McMurray (1935) relieves pain in selected cases but is by no means applicable to all. Prolonged post-operative plaster immobilisation is necessary but is not borne well by older patients. Cordotomy is a grave and uncertain expedient. Manipulation seldom relieves pain. Tavernier and Godinot (1945) claim success for denervation but confirmation is still lacking. The injection method of \Vaugh (1945) is only occasionally effective. The operation of pseudarthrosis, as first performed by Girdlestone in 1923, was a modification of the method advocated by Sir Robert Jones (1921) for ankylosis of the hip joint, in which the greater trochanter with its attached muscles was attached to the stump of the femoral neck after excision of the head. The term pseudarthrosis of the hip joint implies in this paper excision of the head and neck of the femur and trimming of the acetabular rim. The advantages claimed are: 1) that it relieves pain; 2) that it corrects deformity; 3) that it restores free movement; and 4) that the benefit gained is permanent. Moreover, a remarkable degree of stability is preserved.