Effectiveness of total hip arthroplasty in the treatment of involved hips in patients with ankylosing spondylitis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Yong ,  SUN Junying , WANG Tao , ZHAO Xijiang , YIN Haibo

Department of Orthopedics, the First Hospital Affiliated to Soochow University, Suzhou Jiangsu, 215006, P.R.China;

Corresponding author：

SUN Junying, Email: sun_junying@hotmail.com

Keywords：

Ankylosing spondylitis; total hip arthroplasty; heterotopic ossification

DOI：

10.7507/1002-1892.201611018

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Objective To summarize the mid- to long-term effectiveness of total hip arthroplasty (THA) in the treatment of the involved hips in patients with ankylosing spondylitis (AS), and to investigate its influencing factors. Methods Between March 1999 and May 2011, 32 patients (42 hips) with AS and involved hip underwent THA. There were 26 males and 6 females with a mean age of 39 years (range, 20-78 years). The disease duration ranged from 2 to 41 years, with a median of 10 years. Metal-on-polyethylene bearings were used in 19 hips, and ceramic-on-ceramic bearings in 23 hips. The diameter of prosthetic femoral head was 36 mm in 15 hips and was 28 mm in 27 hips; and all the prostheses were fixed biologically. The Harris score, visual analogue scale (VAS) score, and total range of motion (ROM) of the hip were compared between at pre- and post-operation to evaluate the effectiveness. The DeLee zone was used for describing acetabular prosthesis, the Gruen zone for describing femoral prosthesis, and the Brooker criterion for evaluating the heterotopic ossification. Results Healing of incision by first intention was achieved in all patients after operation. There was no complication of anesthetic accident, infection, or neurovascular injury. Twenty-nine cases (39 hips) were followed up 5-17 years (mean, 9 years). Anterior dislocation of hip joint occurred in 2 hips of 24 hips (28 mm diameter), but did not in 15 hips (36 mm diameter). At last follow-up, the Harris score, VAS score, and the total hip ROM were significantly improved (P<0.05). The shorter the disease duration was, the higher postoperative Harris score and the greater postoperative total hip ROM would be (P<0.05); the bigger diameter of prosthetic femoral head was, the greater postoperative total hip ROM would be (P<0.05). All the acetabular components and femoral stems were well fixed at last follow-up. The osteolysis rate around the acetabular cup in the metal-on-polyethylene bearing group (50%, 9/18) was higher than that in the ceramic-on-ceramic bearing group (0, 0/21). No prosthetic loosening was observed in 2 groups. Seven hips were found to have heterotopic ossification, including 5 hips of Brooker grade I and 2 hips of Brooker grade II. Conclusion THA is an effective method to treat involved hips in patients with AS; especially for patients having shorter duration of the disease, THA shows better effectiveness when the bigger diameter of prosthetic femoral head and ceramic-on-ceramic bearing are used.

Citation： LIUYong, SUNJunying, WANGTao, ZHAOXijiang, YINHaibo. Effectiveness of total hip arthroplasty in the treatment of involved hips in patients with ankylosing spondylitis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(1): 25-30. doi: 10.7507/1002-1892.201611018 Copy

1.	Kubiak EN, Moskovich R, Errico TJ, et al. Orthopaedic Management of Ankylosing Spondylitis. J Am Acad Orthop Surg, 2005, 13(4): 267-278.
2.	Feldtkeller E, Khan MA, van der Heijde D, et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int, 2003, 23(2): 61-66.
3.	Braun J, Bollow M, Remlinger G, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum, 1998, 41(1): 58-67.
4.	Joshi AB, Markovic L, Hardinge K, et al. Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips. J Arthroplasty, 2002, 17(4): 427-433.
5.	Dheerendra S, Khan W, Saeed MZ, et al. Recent developments in total hip replacements: cementation, articulation, minimal-invasion and navigation. J Perioper Pract, 2010, 20(4): 133-138.
6.	吴剑, 蔡贤华, 游洪波, 等. 强直性脊柱炎 THA 术后假体脱位的危险因素分析. 中国骨与关节损伤杂志, 2014, 29(12): 1248-1249.
7.	Bisla RS, Ranawat CS, Inglis AE. Total hip replacement in patients with ankylosing spondylitis with involvement of the hip. J Bone Joint Surg (Am), 1976, 58(2): 233-238.
8.	Bartz RL, Noble PC, Kadakia NR, et al. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg (Am), 2000, 82(9): 1300-1307.
9.	Hannouche D, Devriese F, Delambre J, et al. Ceramic-on-ceramic THA implants in patients younger than 20 years. Clin Orthop Relat Res, 2016, 474(2): 520-527.
10.	Wang T, Sun JY, Zhao XJ, et al. Ceramic-on-ceramic bearings total hip arthroplasty in young patients. Arthroplasty Today, 2016, 2(4): 205-209.
11.	D'Antonio JA, Capello WN, Naughton M. Ceramic bearings for total hip arthroplasty have high survivorship at 10 years. Clin Orthop Relat Res, 2012, 470(2): 373-381.
12.	van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: A proposal for modification of the New York criteria. Arthritis Rheum, 1984, 27(4): 361-368.
13.	孙俊英, 唐天驷, 洪天禄, 等. 全髋置换术治疗强直性脊柱炎合并髋关节强直 11 例报告. 江苏医药, 1995, 21(1): 5-7.
14.	Tang WM, Chiu KY. Primary total hip arthroplasty in Patients with ankylosing spondylitis. J Arthroplasty, 2000, 15(1): 52-58.
15.	方远, 孙俊英, 查国春, 等. 采用超大生物型臼杯行髋关节翻修术的疗效观察. 中国修复重建外科杂志, 2013, 27(12): 1424-1427.
16.	Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain, 1986, 27(1): 117-126.
17.	DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
18.	Dorr LD. Total hip replacement using APR system. Tech Orthop, 1986, 1(3): 22-34.
19.	Gruen TA, McNeice GM, Amstutz HC. “Modes of failure”of cemented stem-type femoral components:a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
20.	Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
21.	Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement.Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
22.	Calin A, Elswood J. The outcome of 138 total hip replacements and 12 revisions in ankylosing spondylitis: high success rate after a mean followup of 7.5 years. J Rheumatol, 1989, 16(7): 955-958.
23.	Walker LG, Sledge CB. Total hip arthroplasty in ankylosing spondylitis. Clin Orthop Relat Res, 1991, (262): 198-204.
24.	Welch RB, Charnley J. Low-friction arthroplasty of the hip in rheumatoid arthritis and ankylosing spondylitis. Clin Orthop Relat Res, 1970, 72: 22-32.
25.	Amstutz HC, Sakai D. Total joint replacement for ankylosed hips. Indications, technique, and preliminary results. J Bone Joint Surg (Am), 1975, 57(5): 619-625.
26.	Ye C, Liu R, Sun C, et al. Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis. Int Orthop, 2014, 38(12): 2473-2476.
27.	史占军, 金大地, 景宗森, 等. 强直性脊柱炎髋关节骨性强直的功能重建. 中华骨科杂志, 2002, 22(5): 267-271.
28.	Bhan S, Eachempati KK, Malhotra R. Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthoplasty, 2008, 23(6): 859-866.
29.	Thilak J, Panakkal JJ, Kim TY, et al. Risk factors of heterotopic ossification following total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty, 2015, 30(12): 2304-2307.
30.	任凯晶, 于建华, 李晓辉, 等. 全髋关节置换术治疗强直性脊柱炎严重屈髋畸形. 中华骨科杂志, 2007, 27(10): 721-725.

1. Kubiak EN, Moskovich R, Errico TJ, et al. Orthopaedic Management of Ankylosing Spondylitis. J Am Acad Orthop Surg, 2005, 13(4): 267-278.
2. Feldtkeller E, Khan MA, van der Heijde D, et al. Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int, 2003, 23(2): 61-66.
3. Braun J, Bollow M, Remlinger G, et al. Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum, 1998, 41(1): 58-67.
4. Joshi AB, Markovic L, Hardinge K, et al. Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips. J Arthroplasty, 2002, 17(4): 427-433.
5. Dheerendra S, Khan W, Saeed MZ, et al. Recent developments in total hip replacements: cementation, articulation, minimal-invasion and navigation. J Perioper Pract, 2010, 20(4): 133-138.
6. 吴剑, 蔡贤华, 游洪波, 等. 强直性脊柱炎 THA 术后假体脱位的危险因素分析. 中国骨与关节损伤杂志, 2014, 29(12): 1248-1249.
7. Bisla RS, Ranawat CS, Inglis AE. Total hip replacement in patients with ankylosing spondylitis with involvement of the hip. J Bone Joint Surg (Am), 1976, 58(2): 233-238.
8. Bartz RL, Noble PC, Kadakia NR, et al. The effect of femoral component head size on posterior dislocation of the artificial hip joint. J Bone Joint Surg (Am), 2000, 82(9): 1300-1307.
9. Hannouche D, Devriese F, Delambre J, et al. Ceramic-on-ceramic THA implants in patients younger than 20 years. Clin Orthop Relat Res, 2016, 474(2): 520-527.
10. Wang T, Sun JY, Zhao XJ, et al. Ceramic-on-ceramic bearings total hip arthroplasty in young patients. Arthroplasty Today, 2016, 2(4): 205-209.
11. D'Antonio JA, Capello WN, Naughton M. Ceramic bearings for total hip arthroplasty have high survivorship at 10 years. Clin Orthop Relat Res, 2012, 470(2): 373-381.
12. van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: A proposal for modification of the New York criteria. Arthritis Rheum, 1984, 27(4): 361-368.
13. 孙俊英, 唐天驷, 洪天禄, 等. 全髋置换术治疗强直性脊柱炎合并髋关节强直 11 例报告. 江苏医药, 1995, 21(1): 5-7.
14. Tang WM, Chiu KY. Primary total hip arthroplasty in Patients with ankylosing spondylitis. J Arthroplasty, 2000, 15(1): 52-58.
15. 方远, 孙俊英, 查国春, 等. 采用超大生物型臼杯行髋关节翻修术的疗效观察. 中国修复重建外科杂志, 2013, 27(12): 1424-1427.
16. Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity: a comparison of six methods. Pain, 1986, 27(1): 117-126.
17. DeLee JG, Charnley J. Radiological demarcation of cemented sockets in total hip replacement. Clin Orthop Relat Res, 1976, (121): 20-32.
18. Dorr LD. Total hip replacement using APR system. Tech Orthop, 1986, 1(3): 22-34.
19. Gruen TA, McNeice GM, Amstutz HC. “Modes of failure”of cemented stem-type femoral components:a radiographic analysis of loosening. Clin Orthop Relat Res, 1979, (141): 17-27.
20. Engh CA, Bobyn JD, Glassman AH. Porous-coated hip replacement. The factors governing bone ingrowth, stress shielding, and clinical results. J Bone Joint Surg (Br), 1987, 69(1): 45-55.
21. Brooker AF, Bowerman JW, Robinson RA, et al. Ectopic ossification following total hip replacement.Incidence and a method of classification. J Bone Joint Surg (Am), 1973, 55(8): 1629-1632.
22. Calin A, Elswood J. The outcome of 138 total hip replacements and 12 revisions in ankylosing spondylitis: high success rate after a mean followup of 7.5 years. J Rheumatol, 1989, 16(7): 955-958.
23. Walker LG, Sledge CB. Total hip arthroplasty in ankylosing spondylitis. Clin Orthop Relat Res, 1991, (262): 198-204.
24. Welch RB, Charnley J. Low-friction arthroplasty of the hip in rheumatoid arthritis and ankylosing spondylitis. Clin Orthop Relat Res, 1970, 72: 22-32.
25. Amstutz HC, Sakai D. Total joint replacement for ankylosed hips. Indications, technique, and preliminary results. J Bone Joint Surg (Am), 1975, 57(5): 619-625.
26. Ye C, Liu R, Sun C, et al. Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis. Int Orthop, 2014, 38(12): 2473-2476.
27. 史占军, 金大地, 景宗森, 等. 强直性脊柱炎髋关节骨性强直的功能重建. 中华骨科杂志, 2002, 22(5): 267-271.
28. Bhan S, Eachempati KK, Malhotra R. Primary cementless total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Arthoplasty, 2008, 23(6): 859-866.
29. Thilak J, Panakkal JJ, Kim TY, et al. Risk factors of heterotopic ossification following total hip arthroplasty in patients with ankylosing spondylitis. J Arthroplasty, 2015, 30(12): 2304-2307.
30. 任凯晶, 于建华, 李晓辉, 等. 全髋关节置换术治疗强直性脊柱炎严重屈髋畸形. 中华骨科杂志, 2007, 27(10): 721-725.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of total hip arthroplasty in the treatment of involved hips in patients with ankylosing spondylitis

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