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

Background: Hip resection arthroplasty (HRA) serves as a salvage treatment option for various conditions affecting paraplegic patients. In nonparaplegic individuals, it is often utilized to manage complex infections. There exists a paucity of studies comparing outcomes between paraplegic and nonparaplegic patients undergoing HRA as definitive treatment. This study aimed to analyze the demographics, indications, outcomes, and complications in these two patient groups.

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

Results: Paraplegic patients exhibited distinct characteristics compared to nonparaplegic 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% of paraplegic and 42.5% of nonparaplegic cases. Nonparaplegic 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 nonparaplegic cases, respectively. However, paraplegic patients exhibited a higher reoperation rate (P = 0.041), while nonparaplegic individuals encountered increased major systemic complications (P = 0.052). Although the total complication rate was slightly higher in the nonparaplegic group (75 versus 56%), the difference was not statistically significant (P = 0.211).

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