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. 2021 Feb 2;16(1):104.
doi: 10.1186/s13018-021-02258-z.

Mid-term results of bilateral synchronous total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis

Lei Han  1 , Renfu Quan  1 , Zhenle Pei  2 , Guoping Cao  1 , Yungen Hu  1 , Jingjing Liu  3
Affiliations

Mid-term results of bilateral synchronous total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis

Lei Han et al. J Orthop Surg Res. .

Abstract

Background: Total hip arthroplasty (THA) for bony ankylosis is technically challenging in patients with ankylosing spondylitis (AS). This study aimed to determine the mid-term results of bilateral synchronous THA for bony ankylosis in patients with AS.

Methods: Nineteen cases of bony ankylosis in patients with AS who received bilateral synchronous THA were included in this study (17 males and 2 females, mean age 49.2 years). Disease duration was 5-38 years (mean 18 years and 6 months). All patients received cementless THA. Intraoperative blood loss, visual analog scale (VAS) score, and complications were assessed. Harris hip scores evaluated the clinical effect.

Results: Patients were followed up for 62-98 months (mean 82.5 months). VAS score decreased from 7.42 ± 0.92 to 2.42 ± 0.83, Harris hip score improved from 21.8 ± 7.2 to 80.3 ± 6.5, and the flexion-extension range of the hip improved from 0 to 142.3 ± 6.2°. One patient with septum bronchiale had a fracture intraoperatively and was treated with wire strapping. One patient had a traction injury of the femoral nerve postoperatively and recovered 1 year after the operation. Loosening and subsidence were not observed in all patients. Heterotopic bone formation was noted in 3 patients. No complications such as joint dislocation, acute infection, and deep vein thrombosis were found.

Conclusion: Bilateral synchronous THA was effective for bony ankylosis of the hip in patients with AS because it improved patients' quality of life and had satisfactory mid-term outcomes.

Keywords: Ankylosing spondylitis; Arthroplasty; Hip; Replacement; Spondylitis.

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Conflict of interest statement

The authors declare that they have no competing interests. There is no funding source.

Figures

Fig. 1
Fig. 1
a Delineation of two-step system. Osteotomy perpendicular to the femoral neck 10 mm from the posterior wall of acetabulum (a). Next, wedge osteotomy was performed (b). The bottom edge of wedge osteotomy is 5 mm (c). b Homann hooks were placed in front and rear of the femoral neck, and osteotomy was performed at the junction of the femoral neck and acetabulum
Fig. 2
Fig. 2
a The perioperative photo showed that the patient flexion deformity bilateral hips were over 45°. b The postoperative photo showed that the hip straightening was achieved immediately
Fig. 3
Fig. 3
a, b Three-dimensional reconstruction showing AS with hip flexion ankylosis and kyphosis deformity. c The radiographs showing bilateral bony ankylosis with 0° range of motion. d Postoperative radiograph of the patient 5 years after cementless THA
See this image and copyright information in PMC

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