Primary total hip arthroplasty in patients with ankylosing spondylitis

doi:10.1016/S0883-5403(00)91155-0

The Journal of Arthroplasty

Volume 15, Issue 1, January 2000, Pages 52-58

https://doi.org/10.1016/S0883-5403(00)91155-0 Get rights and content

Abstract

The results of total hip arthroplasty in a group of patients with ankylosing spondylitis are described. Ninety-five arthroplasties were performed in 56 men and 2 women whose average age at operation was 38.9 years (standard deviation [SD], 11.6; range, 19.2–78.8). They were followed for an average of 135.4 months (SD, 81.6; range, 24.4–331.2). We encountered 4 deep infections necessitating the removal of prostheses. Two of 3 dislocations were anterior dislocations. Nineteen arthroplasties were revised at an average of 162.0 months (SD, 49.6; range, 55.1–250.5) after the primary surgery; 9 of them had only the acetabular component revised because of aseptic loosening. Hyperextenson of the hips is a common phenomenon that can lead to surgical error and predispose the prosthesis to anterior dislocation.

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Cited by (121)

Revision total hip arthroplasty in patients with ankylosing spondylitis: Mid-term results
2023, Orthopaedics and Traumatology: Surgery and Research
Citation Excerpt :
The reason for poor ROM may be related to high soft tissue tension and inadequate rehabilitation. The low dislocation rate (1.9% at 7.5 years) in this cohort, which was similar with some previous studies [37,39], but differed from others [5,24,40], might be partially explained by the residual hip joint stiffness after revision. The low ROM and low physical activity level explain the low number of dislocations.
Few studies have reported on the outcome of revision total hip arthroplasty (THA) for ankylosing spondylitis (AS). Therefore, we sought to investigate the clinical and radiographic outcomes of revision THA in patients with AS.
The mid-term outcome of revision THA in AS patients was comparable to conventional revision THA.
Forty-one patients with AS who underwent revision THA (on a total of 51 hips) between April 2004 and June 2018 were included. The mean follow-up duration was 7.5 ± 3.6 years (3.0–15.8 years). Clinical outcomes were assessed using the Bath Ankylosing Spondylitis Functional Index (BASFI), Harris Hip Score (HHS), and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index. Complications were assessed at each follow-up. Radiological outcomes were examined by reviewing postoperative plain radiographs.
Significant improvements were seen in BASFI, HHS, and WOMAC scores (p < 0.01). Postoperative combined range of motion (ROM) was 128.9 ± 45.3° (range, 60–300°). Complications included heterotopic ossification, periprosthetic fractures, aseptic loosening, osteolysis, reinfection, residual pain or stiffness, delayed wound healing, numbness, deep vein thrombosis, leg length discrepancy, and posterior dislocation. Five (9.8%) of the 51 hips were treated with re-revision due to aseptic loosening, re-infection, or re-fracture. The incidence of dislocation was 1.9% at 7.5 years. Implant survival for all reasons was estimated to be 96.3% at 5 years, 85.9% at 10 years and 61.0% at 15 years. Forty-two (82.4%) hip revisions were rated “satisfactory” or “very satisfactory” by the patients.
The mid-term result of revision THA for patients with AS is comparable to conventional revisions in terms of implant survival, despite high complication rates. The benefit-risk ratio of these indications is acceptable but deserves specific information for these patients.
IV; case series.
Primary Total Hip Arthroplasty in Patients With Ankylosing Spondylitis
2021, Journal of Arthroplasty
Ankylosing spondylitis (AS) is a common inflammatory spondyloarthropathy with hip involvement in 40% of patients. With the renewed interest in the hip-spine interplay, this study aimed to define long-term outcomes of primary total hip arthroplasty (THA) in the setting of AS.
We identified 309 hips (219 patients) with AS treated with primary THA from 1969 to 2018. Mean age was 49 years, 80% were males, and mean body mass index was 28 kg/m². Cumulative incidences of any revision, reoperation, and dislocation were calculated utilizing a competing risk analysis. Harris Hip Scores and complications were also reported. Mean follow-up was 16 years.
The cumulative incidence of any revision after primary THA was 2.3% at 5 years and 17.5% at 20 years. The most common reasons for revision (n = 73) were aseptic loosening (41%), osteolysis/polyethylene (PE) wear (30%, all with conventional PE), and femoral component fracture (8%). The cumulative incidence of dislocation was 1.9% at 5 years and 2.9% at 20 years. Younger age was associated with increased risk of revision (hazard ratio (HR) = 1.3, P < .01) and reoperation (HR = 1.2, P < .01), but not dislocation (HR = 0.7, P = .1). Twenty-eight hips (9%) experienced a postoperative complication not requiring reoperation. The mean Harris Hip Score improved from 51 to 76 after THA (P < .001).
In this series of 309 primary THAs in patients with AS, the 20-year cumulative incidence of any revision after primary THA was 17.5%. Aseptic loosening, osteolysis/PE wear, and femoral component fracture were the most common reasons for revision. Notably, the cumulative incidence of dislocation at 20 years was only 2.9%.
Level IV.
Short to long term outcomes of 154 cemented total hip arthroplasties in ankylosing spondylitis
2021, Journal of Clinical Orthopaedics and Trauma
Citation Excerpt :
In the study by Tang et al. in 2000, they had 95 cemented hips done for AS, with an average follow-up of more than 10 years. In their study they reported favourable outcomes in terms of pain and post-operative function and their revision rate was close to 20%.18 Sochart and Porter in 1997 in one of the largest series at the time looked at the long-term results of cemented THA in patients with AS over an average follow-up period of 22.7 years.
Long-term outcome of Total Hip arthroplasty (THA) in Ankylosing Spondylitis (AS) remains unreported. Literature suggests a higher overall failure rate in ankylosing spondylitis as compared to osteoarthritis. Concern has been expressed regarding joint survival, given that recipients are generally young. The results of cemented THA in patients with ankylosing spondylitis were studied to determine the utility of THA for these patients.
Consecutive series of 96 patients (77 males (80%) and 19 females (20%)) with ankylosing spondylitis who underwent 154 cemented THAs at a tertiary referral orthopaedic centre between January 1990–September 2015 were retrospectively analyzed for clinical and radiological outcomes; 58 patients (60.4%) underwent bilateral surgery.
Mean age at surgery was 48 years. Average follow up was 12.8 (2.1–24.8) years. 95% of the patients had a good or excellent post-operative outcome.
Out of the total 154 hips operated on, 11% (17 hips) developed post-operative complications. Overall, 15 hips (9.7%) required a revision of the procedure, with the most common indication being aseptic loosening of the acetabulum. Average time to revision was 8.5 years (2–15). Survivorship analysis revealed probability of survival of both components at the end of 10 years, with revision due to any reason as the end point to be 92% (with 95% confidence intervals).
21 hips (14%) developed heterotopic ossification post-operatively, of which 4 patients (2%) had clinically significant ossification (Brooker III or IV).
This is one of the largest series of patients with ankylosing spondylitis with long term follow up available. Cemented THA in patients with ankylosing spondylitis provided consistently good and predictable long term results, with low rate of complications and revisions.
Robotic-Arm Assistance Simplifies Hip Arthrodesis Conversion to Total Hip Arthroplasty
2020, Arthroplasty Today
Hip fusion takedown to total hip replacement is a challenging operation. Neck osteotomy and acetabular component placement are technically demanding and often require fluoroscopic guidance. Robotic arm–assisted total hip arthroplasty enhances accuracy of preoperative planning and provides navigated guidance for neck osteotomy and haptic guidance on acetabular reaming and cup implantation. Fluoroscopic guidance is replaced by real-time navigation and on-screen data. This article describes how robotic arm assistance can simplify this complex operation.
Do All Rigid and Unbalanced Spines Present the Same Risk of Dislocation After Total Hip Arthroplasty? A Comparison Study Between Patients With Ankylosing Spondylitis and History of Spinal Fusion
2020, Journal of Arthroplasty
Spines with ankylosis or with a history of lumbosacral fusions have been collectively classified as rigid and unbalanced, and associated with an increased rate of dislocation after total hip arthroplasty (THA). It remains unknown whether the cause of spinal arthrodesis influences the dislocation rate.
A retrospective study was conducted from January 2000 to December 2017, with an institutional review board's approval to identify 2 cohorts with a history of THA: one with ankylosing spondylitis (AS) involving the lumbosacral spine and another cohort with a history of lumbosacral spinal fusion (SF). A chart review was performed to collect demographic and surgical variables. Lumbar lordosis angle (LLA), acetabular anteversion, and inclination angle measurements were taken for each patient. Kaplan-Meier survivorship curves were constructed and multivariable Cox regression was performed for analysis.
The AS and SF cohorts consisted of 142 and 135 patients, respectively. The SF group had a greater mean LLA (34.18°) than the AS group (21°). A total of 16 patients (11.85%) suffered from dislocation after primary elective THA in the SF group, whereas 4 patients (2.82%) in the AS group. After multivariable Cox regression analysis, increasing LLA and hips outside of the Lewinnek safe zone were found to be associated with a higher hazard of dislocation after THA.
We found that the degree of lumbar spine curvature is more associated with dislocation after THA than the history of SF itself; specifically, an increase in lumbar lordosis angle of 1º increases the probability of dislocation by 13% among AS and SF patients.
Pelvic flexion/extension and its impact on functional acetabular alignment and stability following total hip replacement
2024, International Orthopaedics

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Original articlePrimary total hip arthroplasty in patients with ankylosing spondylitis

Abstract

J Arthroplasty

Long-term results of total hip replacement in young patients who had ankylosing spondylitis: eighteen to thirty-year results with survivorship analysis

J Bone Joine Surg Am

A review of 100 patients with ankylosing spondylitis with particular reference to socio-economic effects

Br J Rheumatol

Total hip replacement in patients with ankylosing spondylitis with involvement of the hip

J Bone Joint Surg Am

Total hip arthroplasty in ankylosing spondylitis

Clin Orthop

Arthroplasty of the hip in ankylosing spondylitis

J Bone Joint Surg Br

The relationship between pelvic, spinal and hip involvement in ankylosing spondylitis—one disease process or several?

Br J Rheumatol

Joint surgery in severe ankylosing spondylitis

Acta Orthop Scand

Total hip replacement in juvenile chronic polyarthritis and ankylosing spondylitis

Clin Orthop

Total hip replacement in ankylosing spondylitis

Acta Orthop Scand

The outcome of 138 total hip replacement and 12 revisions in ankylosing spondylitis: high success rate after a mean follow-up of 7.5 years

J Rheumatol

Total hip replacement for patients who have ankylosing spondylitis: the importance of the formation of heterotopic bone and of the durability of fixation of cemented components

J Bone Joint Surg Am

Assessment of long-term benefit of total hip replacement in patients with ankylosing spondylitis

J Rheumatol

Total hip arthroplasty in patients with ankylosing spondylitis: long-term follow-up

J Rheumatol

Low-friction arthroplasty of the hip in rheumatoid arthritis and ankylosing spondylitis

Clin Orthop

Corrective osteotomy of the spine in ankylosing spondylitis: experience with 66 cases

Clin Orthop

Original article
Primary total hip arthroplasty in patients with ankylosing spondylitis