[Mid-term results of total hip arthroplasty for treatment of ankylosing spondylitis]

Liang Zhang, Hui Xu, Xiaozhong Guo, Yixin Zhou
Chinese Journal of Reparative and Reconstructive Surgery 2014, 28 (1): 1-6

OBJECTIVE: To investigate the clinical and radiographic results of total hip arthroplasty (THA) for the treatment of hip arthrosis in patients with ankylosing spondylitis (AS).

METHODS: A retrospective analysis was made on the clinical data from 131 patients (195 hips) who underwent THA for AS between September 2001 and August 2011 with a follow-up period of more than 2 years. There were 100 males (152 hips) and 31 females (43 hips), aged 17-69 years (mean, 33.7 years). The average interval between AS onset and THA was 13.7 years (range, 1-50 years). The left hips were involved in 30 cases, the right hips in 37 cases, and bilateral hips in 64 cases. Preoperative Harris hip score was 18.0 +/- 13.7; the sum passive range of motion was (36.2 +/- 51.2) degrees; and the hip passive-flexion arc was (23.4 +/- 32.6) degrees. In 175 hips with passive flexion of less than 90 degrees, 134 hips had flexion contracture. Based on preoperative X-ray films and CT scan, 195 hips were divided into the non-ankylosed subgroup (86 hips), fibrous ankylosed subgroup (43 hips), and bony ankylosed subgroup (66 hips); and the recovery of hip function was compared between subgroups after operation.

RESULTS: Intraoperative complications included linear fractures of femoral calcar in 4 hips, fractures of acetabular posterior column in 1 hip, femoral shaft fractures in 2 hips, and iatrogenic sciatic nerve injury in 3 hips; postoperative complications included anterior dislocation in 2 hips. The average follow-up period was 51.3 months (range, 24-143 months). Bone healing was observed at 3-6 months after operation (mean, 3.9 months). At last follow-up, the average Harris hip score increased to 86.4 +/- 14.1, the sum passive range of motion increased to (202.0 +/- 28.0) degrees, and the hip passive-flexion arc increased to (93.2 +/- 15.3) degrees, all showing significant differences when compared with preoperative ones (P < 0.05). Based on a four-class scale for subjective satisfaction, the patients were very satisfied, satisfied, and not satisfied with the results of THA in 100, 80, and 15 hips respectively. X-ray films showed radiolucent line (< 2 mm) in 5 acetabular components (zones I and II); heterotopic ossification was observed in 49 hips after THA. There was no significant difference in the Harris hip score among 3 subgroups after THA at last follow-up (P > 0.05). At last follow-up, the degree of passive flexion in the fibrous ankylosed subgroup and bony ankylosed subgroup was significantly lower than that in the non-ankylosed subgroup (P < 0.05), and the sum passive range of motion in the fibrous ankylosed subgroup was significantly lower than that in the non-ankylosed subgroup (P < 0.05), but no significant difference was found in the other variables among the 3 sub groups (P > 0.05).

CONCLUSION: For severe hip arthrosis in patients with AS, the overall outcomes after THA are ideal with a good midterm prosthetic survivorship, a low complication rate, and a high satisfaction of patients. However the hip function after THA is still less satisfactory. [Key words] Ankylosing spondylitis Total hip arthroplasty Hip function Mid-term result

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