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Falgiano PA, Rowland RJ, Heifner JJ, Corces A. Dual-mobility with modular components for primary total hip arthroplasty in bilateral bony ankylosis of the hips: A case report. Int J Surg Case Rep 2024; 122:110161. [PMID: 39159594 DOI: 10.1016/j.ijscr.2024.110161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 08/08/2024] [Accepted: 08/10/2024] [Indexed: 08/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary total hip arthroplasty (THA) is a procedure performed in the United States for a variety of indications, with operation rates slated to increase over 275 % by 2040 when compared to 2014 (Thilak et al., 2015). Dual-mobility (DM) implants have gained popularity in the United States since gaining approval in the early 2010s (Heckmann et al., 2020). It has been well reported that DM implants decrease the risk of dislocation after primary and revision THA (Vielpeau et al., 2011; Donovan et al., 2022; Heifner et al., 2023; Foissey et al., 2023; Schmidt et al., 2020; Neri et al., 2019). CASE PRESENTATION We present the case of a 33-year-old male with a suspected ankylosing spondylitis (AS) diagnosis and bilateral bony ankylosis of the hips who underwent staged THA with modular dual-mobility (MDM) implants. At one year post-operatively, the patient is walking without the use of an assistive device and reports a VAS pain score of 0 at rest and 2 with activity and HHS of 90. CLINICAL DISCUSSION Implant selection is important in this patient population due to the increased risk of dislocation. Contemporary reports reveal MDM implants have demonstrated a substantial reduction in dislocation risk compared to fixed-bearing implants in patients with a high risk of dislocation. We opted to place the acetabular component inside the safe zone to improve stability and use the dual-mobility prosthesis to achieve our desired range of motion. CONCLUSION The improved stability of DM implants allows for a greater range of acetabular positions in patients who have a highly unpredictable functional outcome at the time of surgery. Our preliminary results contribute to the growing list of indications for MDM total hip arthroplasty.
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Affiliation(s)
| | - Robert J Rowland
- Larkin Hospital Department of Orthopedic Surgery, Miami, FL, USA
| | | | - Arturo Corces
- Larkin Hospital Department of Orthopedic Surgery, Miami, FL, USA
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Beheshti Fard S, Afzal S, Barzegar M, Mortazavi SMJ. Single-stage bilateral conversion arthroplasty for hip fusion via direct anterior approach in a patient with severe ankylosing spondylitis and kyphoscoliosis: a case report. J Med Case Rep 2023; 17:508. [PMID: 38072934 PMCID: PMC10712173 DOI: 10.1186/s13256-023-04251-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Severe ankylosing spondylitis (AS) frequently involves hip joints and, occasionally, presents with concurrent spinal deformities, such as kyphoscoliosis, creating complex challenges for surgical management. CASE PRESENTATION We present a 26-year-old Persian male with a history of AS and severe kyphoscoliosis, leading to bilateral hip fusion and immobility. Following spinal deformity correction, a one-stage bilateral conversion to total hip arthroplasty (THA) was conducted through the direct anterior approach. CONCLUSION Primary correction of spinal deformities allows for extended surgical procedures under general anesthesia. Single stage bilateral hip conversion arthroplasty via the direct anterior approach enhances postoperative mobilization, reduce the risk of re-ankylosis, and improve the overall quality of life for AS patients with this unique presentation.
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Affiliation(s)
| | - Sina Afzal
- Department of Orthopedic Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Barzegar
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Peters J, Köhler HC, Gutcke A, Schulze C. [Proximal femoral fracture with bony ankylosis of the hip joint : Case report of difficult surgical treatment]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:904-908. [PMID: 36912969 DOI: 10.1007/s00113-023-01307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 03/14/2023]
Abstract
A 78-year-old female patient sustained a left-sided proximal femoral fracture due to a fall. Since childhood the patient had suffered from ankylosis of unknown origin in the ipsilateral hip joint. The recommended intramedullary osteosynthesis could restore the original status quo before the fracture. It needs less time in the operating room (OR) and includes a lower risk for intraoperative complications than a hip joint endoprosthesis. Arthroplasty can lead to a significant improvement in mobility of the hip joint but requires more time in the OR for the surgical procedure and anesthesia time and includes a higher risk for intraoperative and postoperative complications. The antetorsion angle of 76° in this patient deviated extremely from the standard and made the intramedullary osteosynthesis for this type of fracture a challenge. Using improvised techniques led to a load-stable fracture treatment that ultimately led to a satisfactory result.
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Affiliation(s)
- Jan Peters
- Klinik für Orthopädie und Unfallchirurgie, Plastische, Rekonstruktive und Handchirurgie, Bundeswehrkrankenhaus Westerstede, Lange Straße 38, 26655, Westerstede, Deutschland.
| | - Hans-Christian Köhler
- Klinik für Orthopädie und Unfallchirurgie, Plastische, Rekonstruktive und Handchirurgie, Bundeswehrkrankenhaus Westerstede, Lange Straße 38, 26655, Westerstede, Deutschland
| | - André Gutcke
- Klinik für Orthopädie und Unfallchirurgie, Plastische, Rekonstruktive und Handchirurgie, Bundeswehrkrankenhaus Westerstede, Lange Straße 38, 26655, Westerstede, Deutschland
| | - Christoph Schulze
- Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland
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Kobayashi T, Morimoto T, Hirata H, Yoshihara T, Tsukamoto M, Sonohata M, Mawatari M. Changes of the coronal lumbar-pelvic-femoral alignment after conversion total hip arthroplasty in patients with unilateral ankylosed hip. Sci Rep 2023; 13:5541. [PMID: 37016148 PMCID: PMC10073074 DOI: 10.1038/s41598-023-32672-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 03/31/2023] [Indexed: 04/06/2023] Open
Abstract
To elucidate the changes in coronal lumbar-pelvic-femoral alignment after conversion total hip arthroplasty (THA) in patients with unilateral ankylosed hip. A retrospective radiologic study of 48 patients (48 hips) with unilateral hip arthrodesis who underwent conversion THA was conducted. Cobb's angle of lumbar scoliosis (LS), the pelvic obliquity (PO) angle, and the hip adduction angle (HAA) on standing anterior-posterior spine-pelvis-hip radiographs were measured before and after THA. The differences of LS, PO, and HAA before and after THA were defined as ΔLS, ΔPO, and ΔHAA, respectively. A paired samples t-test or the Wilcoxon signed-rank test were used to compare the absolute values of the LS, PO, and HAA between preoperative and postoperative groups. The Pearson's correlation coefficient (r) or Spearman's correlation coefficient (ρ) was calculated to assess the relationship between ΔLS, ΔPO, and ΔHAA and possible associated factors. Significant differences were found in the preoperative LS (mean, 10.8° vs. 8.2°, p = 0.004), PO (median, 6.8° vs. 2.0°, p < 0.001), and HAA (median, 10.0° vs. 6.0°, p = 0.003). ΔLS was correlated with the preoperative LS (ρ = - 0.621, p < 0.001), PO (ρ = - 0.580, p < 0.001), and HAA (ρ = - 0.467, p < 0.001). ΔPO was correlated with the preoperative LS (r = - 0.596, p < 0.001), PO (ρ = - 0.892, p < 0.001), and HAA (ρ = - 0.728, p < 0.001). ΔHAA was correlated with the preoperative LS (r = - 0.583, p < 0.001), PO (ρ = - 0.751, p < 0.001), and HAA (ρ = - 0.824, p < 0.001). LS, PO, and HAA were significantly improved after conversion THA. Greater improvement in LS, PO, and HAA can be expected in patients with larger preoperative LS, PO, and HAA values.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
- Department of Preventive Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan.
| | - Hirohito Hirata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Tomohito Yoshihara
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Masatsugu Tsukamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
| | - Motoki Sonohata
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
- Department of Orthopaedic Surgery, Japan Community Health Care Organization (JCHO) Saga Central Hospital, 3-8-1 Hyogo Minami, Saga, 849-8522, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, 849-8501, Japan
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Dubinin AO, Khramov AE, Dubinina TV, Ilinykh EV, Bialik EI. Intraoperative picture of hip joint lesion in ankylosing spondylitis: data from a retrospective analysis. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-594-598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In population of Russian patients with ankylosing spondylitis (AS), the frequency of clinical manifestations (pain and limitation of functions) of coxitis reaches 56%. Total hip arthroplasty (THA) can be considered as the only alternative that can relieve the suffering of the patient. Radiography and magnetic resonance imaging are widely used methods for assessing structural damage to the hip joint in AS. However, at the moment these methods can’t allow us to fully describe the lifetime changes of these joints. The aim of the study: to analyze the external changes of the femoral heads (HF) and acetabulums during the THA in patients with AS. Materials and methods. The retrospective study included 170 patients with a reliable diagnosis of AS, who met the modified New York criteria of 1984, who were treated in the traumatological and orthopedic department of the V.A. Nasonova Research Institute of Rheumatology in the period from 1998 to 2020, all patients underwent THA as planned. Most of them were male (80.6%). The average age of patients was 38.1±11.3 years and the average duration of the disease since the onset of the first symptoms was 17.0±8.5 years. The duration of pain in hip joints before performing THA is 7.4±4.8 years. The assessment of macroscopic changes in the FH and acetabulum was performed intraoperatively. Results and discussion. Acetabulum protrusion was detected in 108 (63.5%) patients, bone cysts – in 65 (38.2%). Filling of acetabulum with granulation tissue was recorded in 155 (91.2%) patients, presence of osteophytes on its edges – in 153 (90%). Cartilage in the acetabulum was completely absent in 122 (71.8%) patients. FH deformation was detected in 98.2% of cases, erosion in 46.4%. Cartilage on FH was completely absent in 130 (76.5%) patients. In 119 (70%) patients, macroscopic signs of osteonecrosis of FH were found. 79 (46.4%) patients had ankylosis of the hip joint, including fibrous ankylosis – in 77.2% of patients and bone ankylosis – in 22.8%. Conclusion. In patients with AS, the necessity for THA occurs on average after 7.4±4.8 years from the moment of the appearance of first clinical signs of coxitis. In 70% of cases, the macroscopic picture of hip joint lesion was characterized by the development of Avascular necrosis of the femur head (AVNFH), in most patients there was no cartilage in the most loaded segments of acetabulum and FH, in almost half of cases – ankylosis of hip joint and mainly fibrous (77.2%).
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Affiliation(s)
| | | | | | | | - E. I. Bialik
- V.A. Nasonova Research Institute of Rheumatology
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Jacob MK, Reddy PK, Kuruvilla RS, John CV, Poonnoose PM, Oommen AT. Functional and clinical outcome with modified lateral approach total hip arthroplasty in stiff hips with ankylosing spondylitis. World J Orthop 2022; 13:714-724. [PMID: 36159621 PMCID: PMC9453278 DOI: 10.5312/wjo.v13.i8.714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/24/2022] [Accepted: 07/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ankylosing spondylitis at total hip arthroplasty (THA) has significant hip stiffness with flexion deformity, restricted mobility, and function. Range of movement (ROM) improvement with good functional outcome is seen following THA in these hips. The modified Hardinge approach without abductor compromise is helpful in these stiff hips with associated flexion deformity.
AIM To assess improvement in ROM and functional outcomes with a modified lateral approach THA in ankylosing spondylitis with stiff hips.
METHODS A total of 69 hips that underwent THA with a modified Hardinge approach in 40 patients were evaluated at a mean follow-up of 38.33 mo. All individuals ambulated with weight-bearing as tolerated and ROM exercises from the 1st postoperative day. Modified Harris hip score and ROM were assessed during follow-up. Quality of life assessments using the 36-item and 12-item short form health surveys were done along with clinical and functional outcomes at follow-up. SPSS 22.0 was used for statistical analysis. The correlation of ROM and functional score change was performed using Pearson’s correlation coefficient.
RESULTS Sixty-nine hips with a significant decrease in ROM preoperatively with 32 clinically fused hips showed significant improvement in flexion range. The mean flexion in 69 hips improved from 29.35 ± 31.38 degrees to 102.17 ± 10.48 degrees. The mean difference of 72.82 with a P value < 0.0001 was significant. In total, 45 out of 69 hips had flexion deformity, with 13 hips having a deformity above 30 degrees. The flexion during the follow-up was below 90 degrees in 3 hips. Eleven hips had flexion of 90 degrees at follow-up, while the remaining 55 hips had flexion above 100 degrees. Modified Harris hip score improved from 17.03 ± 6.02 to 90.66 ± 7.23 (P value < 0.0001). The 36-item short form health survey at the follow-up indicated health status in 40 patients as excellent in 11, very good in 20, good in 5, fair in 3, and poor in 1. The mean mental health score was 84.10 ± 11.58. Pain relief was good in all 69 hips. Altogether, 28/40 patients (70%) had no pain, 9 patients (22%) had occasional pain, and 3 patients (8%) had mild to moderate pain with unusual activity. Heterotopic ossification was seen in 21 hips with Brooker class 1 in 14 hips.
CONCLUSION Modified Hardinge approach THA in ankylosing spondylitis with stiff hips with flexion deformity significantly improved ROM, Harris hip score, and quality of life indicated by the 36-item and 12-item short form health surveys.
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Affiliation(s)
- Mathew Kiran Jacob
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
| | - Pavan Kumar Reddy
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
| | - Roncy Savio Kuruvilla
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
| | | | | | - Anil Thomas Oommen
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, India
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Tsai SHL, Lau NC, Chen WC, Chien RS, Tischler EH, Fu TS, Chen DWC. Total hip arthroplasty has higher complication rates in stiff spine patients: a systematic review and network meta-analysis. J Orthop Surg Res 2022; 17:353. [PMID: 35842632 PMCID: PMC9288065 DOI: 10.1186/s13018-022-03237-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Ankylosing spondylitis (AS) and spinal fusion (SF) classified as stiff spines have been associated with the increased rate of complications following total hip arthroplasty (THA). However, the differences between the two cohorts have inconsistent evidence. METHODS We searched for studies comparing complications among stiff spine patients, including SF and AS, who underwent THA in PubMed/MEDLINE, Embase, Cochrane CENTRAL, Web of Science, and Scopus until March 2021. Studies detailing rates of mechanical complications, aseptic loosening, dislocation, infection, and revisions were included. We performed network meta-analyses using frequentist random-effects models to compare differences between cohorts. We used P-score to rank the better exposure with the lowest complications. RESULTS Fourteen studies were included in the final analysis. A total of 740,042 patients were included in the systematic review and network meta-analysis. Mechanical complications were highest among SF patients (OR 2.33, 95% CI 1.86, 2.92, p < 0.05), followed by AS patients (OR 1.18, 95% CI 0.87, 1.61, p = 0.82) compared to controls. Long Spinal Fusions had the highest aseptic loosening (OR 2.33, 95% CI 1.83, 2.95, p < 0.05), dislocations (OR 3.25, 95% CI 2.58, 4.10, p < 0.05), infections (OR 2.14, 95% CI 1.73, 2.65, p < 0.05), and revisions (OR 5.25, 95% CI 2.23, 12.32, p < 0.05) compared to AS and controls. Our results suggested that SF with longer constructs may be associated with higher complications in THA patients. CONCLUSIONS THAs following SFs have higher mechanical complications, aseptic loosening, dislocations, and infections, especially with longer constructs. AS patients may have fewer complications compared to this cohort.
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Affiliation(s)
- Sung Huang Laurent Tsai
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, 204, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ngi Chiong Lau
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, 204, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Wei Cheng Chen
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
| | - Ruei-Shyuan Chien
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
| | - Eric H Tischler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Linkou Branch, Linkou, Taiwan
| | - Dave Wei-Chih Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung, 204, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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Li L, Fu J, Xu C, Ni M, Chai W, Hao L, Zhou Y, Chen J. Fourth‐Generation Ceramic‐on‐Ceramic THA
in Patients with Ankylosing Spondylitis: A Minimum
10‐Year Follow‐Up. Orthop Surg 2022; 14:860-867. [PMID: 35434922 PMCID: PMC9087442 DOI: 10.1111/os.13259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 02/05/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To report the long‐term outcomes of total hip arthroplasty (THA) with fourth‐generation ceramic‐on‐ceramic (CoC) bearing in patients with ankylosing spondylitis (AS). Methods We retrospectively identified 180 primary THAs performed in 110 patients with AS, including 100 (90.9%) men and 10 women (9.1%), from 2009 to 2011.The mean age of the patients at surgery was 33 years (range, 16 to 65 years). Cementless prostheses with fourth‐generation CoC bearings were used in all patients. Survivorship of the implants and postoperative complications were calculated. Functional improvement was assessed by the hip flexion‐extension range of motion (ROM) and Harris hip score (HHS). A special noise assessment questionnaire was performed at the last follow‐up. The cumulative incidence of noise was calculated by the Kaplan–Meier method with 95% confidence intervals (CIs). Clinical characteristics and functional outcomes were compared in the hips with noise to those without noise. Results The mean follow‐up was 11 years (range, 10 to 12 years), and survivorship of the implants was 99.4% at the most recent follow‐up. The complications included dislocation (one hip, 0.6%), periprosthetic joint infection (one hip, 0.6%), mild to moderate pain (five hips, 2.8%), heterotopic ossification (12 hips, 6.7%), and noise (52 hips, 28.9%). The flexion‐extension ROM improved significantly with a median from 10° (range, 0 ~ 130°) to 100° (30 ~ 130°) after THA (p < 0.001), and the HHS increased significantly from 41 ± 20 to 90 ± 8 (p < 0.001). The cumulative incidence of noise at 0.5, 5, and 10 years was 6.1% (95% CI, 2.6 ~ 9.6), 16.7% (95% CI, 11.2 ~ 22.1), and 28.9% (95% CI, 22.2 ~ 35.5), respectively, and that of squeaking at 0.5, 5, and 10 years was 4.4% (95% CI, 1.4 ~ 7.4), 13.3% (95% CI, 8.4 ~ 18.3), and 23.9% (95% CI, 17.6 ~ 30.1), respectively. None of the patients with noise generation in the hip reported it affecting daily activities or causing dissatisfaction. No differences in age, sex, BMI, disease duration, bilateral THA, the frequency of bony ankylosis, the proportion of using a 36‐mm‐diameter femoral head, pre/postoperative flexion‐extension ROM, or pre/postoperative HHS were found between hips with noise and those without noise (p > 0.05). Conclusion THAs with fourth‐generation CoC bearings exhibit excellent long‐term survival and clinical outcomes in patients with AS, with a very low dislocation rate. The incidence of noise associated with CoC bearings in THA performed in patients increases over time, but it does not affect postoperative hip function or daily activities.
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Affiliation(s)
- Liangliang Li
- Medical School of Chinese PLA Beijing China
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
- Department of Orthopeadics The Second Hospital of Shanxi Medical University Taiyuan China
| | - Jun Fu
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Chi Xu
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Ming Ni
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Wei Chai
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Libo Hao
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Yonggang Zhou
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
| | - Jiying Chen
- Department of Orthopeadics, The First Medical Centre Chinese PLA General Hospital Beijing China
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Oommen AT, Hariharan TD, Chandy VJ, Poonnoose PM, A AS, Kuruvilla RS, Timothy J. Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis. World J Orthop 2021; 12:970-982. [PMID: 35036339 PMCID: PMC8696600 DOI: 10.5312/wjo.v12.i12.970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/06/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Ankylosing spondylitis (AS) is characterized by involvement of the spine and hip joints with progressive stiffness and loss of function. Functional impairment is significant, with spine and hip involvement, and is predominantly seen in the younger age group. Total hip arthroplasty (THA) for fused hips with stiff spines in AS results in considerable improvement of mobility and function. Spine stiffness associated with AS needs evaluation before THA. Preoperative assessment with lateral spine radiographs shows loss of lumbar lordosis. Spinopelvic mobility is reduced with change in sacral slope from sitting to standing less than 10 degrees conforming to the stiff pattern. Care should be taken to reduce acetabular component anteversion at THA in these fused hips, as the posterior pelvic tilt would increase the risk of posterior impingement and anterior dislocation. Fused hips require femoral neck osteotomy, true acetabular floor identification and restoration of the hip center with horizontal and vertical offset to achieve a good functional outcome. Cementless and cemented fixation have shown comparable long-term results with the choice dependent on bone stock at THA. Risks at THA in AS include intraoperative fractures, dislocation, heterotopic ossification, among others. There is significant improvement of functional scores and quality of life following THA in these deserving young individuals with fused hips and spine stiffness.
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Affiliation(s)
- Anil Thomas Oommen
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, Tamil Nadu, India
| | | | - Viruthipadavil John Chandy
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, Tamil Nadu, India
| | - Pradeep Mathew Poonnoose
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, Tamil Nadu, India
| | - Arun Shankar A
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, Tamil Nadu, India
| | - Roncy Savio Kuruvilla
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, Tamil Nadu, India
| | - Jozy Timothy
- Unit 2, Department of Orthopaedics, Christian Medical College Hospital, Vellore 632004, Tamil Nadu, India
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Mou P, Li H, Chen AJ, Ji Z, Dai XY, Zhou ZK. Cementless total hip arthroplasty for three different degrees of hip involved secondary to ankylosing spondylitis: an analysis of 195 hips. J Orthop Surg Res 2021; 16:608. [PMID: 34656166 PMCID: PMC8520615 DOI: 10.1186/s13018-021-02742-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 09/21/2021] [Indexed: 02/08/2023] Open
Abstract
Background Hip involved secondary to ankylosis spondylitis (AS) had a huge influence on hip function. Cementless total hip arthroplasty (THA) can improve hip function. However, no previous study compared the outcomes of THA for AS patients with three different degrees of hip involvement. Methods The 195 hips were retrospectively analyzed and divided into non-ankylosed group (group A, 94 hips), fibrous ankylosed group (group B, 49 hips), and bony ankylosed group (group C, 52 hips). postoperative range of motion (ROM), harris hip scores (HHS), the short-form 12 health survey (SF-12), length of stay (LOS), cost, radiological assessments, and complications were compared. Results The follow-up time was (79.4 ± 29.5) months for group A, (80.6 ± 28.9) months for group B, and (79.1 ± 28.9) months for group C (P = 0.966). Group A had the best postoperative hip ROM (P < 0.001), while group A and B can realize better HHS than group C (P < 0.001). The three groups had similar SF-12 postoperatively. For group A, LOS and cost for unilateral procedure were the least than that for group B and C (P = 0.003 and P = 0.001). Similar radiological assessments were achieved for three groups. 1 hip in group A encountered delay union of wound. 1 hip in group C encountered delay union of wound and dislocation and another patient encountered femoral fracture intraoperatively. 12 hips (12.8%) in group A, 6 hips (12.2%) in group B, and 6 hips (11.5%) in group C encountered asymptomatic heterotopic ossification (P = 0.977). Conclusion For AS patients with hip involvement, THA can improve hip ROM and function. THA for the non-ankylosed hip can realize the better hip function and postoperative ROM than ankylosed hip.
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Affiliation(s)
- Ping Mou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, #37 Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Hua Li
- Department of Rehabilitation Medicine, Jiang You Second People's Hospital, #10 Tuanshan Road, Jiang you, 621702, People's Republic of China
| | - An-Jing Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, #37 Guoxue Road, Chengdu, 610041, People's Republic of China
| | - Zheng Ji
- West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xin-Yi Dai
- West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zong-Ke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, #37 Guoxue Road, Chengdu, 610041, People's Republic of China.
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11
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Li L, Fu J, Xu C, Ni M, Chai W, Hao L, Zhou Y, Chen J. Hip Replacement in Ankylosing Spondylitis Patients with Advanced Hip Involvement: Factors Associated with Bilateral Total Hip Arthroplasty. Int J Gen Med 2021; 14:6857-6862. [PMID: 34703290 PMCID: PMC8526512 DOI: 10.2147/ijgm.s336314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/01/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND This study aimed to compare the clinical data of ankylosing spondylitis (AS) patients who underwent unilateral and bilateral total hip arthroplasty (THA) due to advanced hip involvement. Furthermore, to determine the factors associated with bilateral THA. METHODS Utilizing a single-institution database, we selected 373 consecutive AS patients undergoing primary THA from 2012 to 2017 and compared the clinical characteristics and anti-tumor necrosis factor (TNF) therapy of the patients who underwent unilateral and bilateral THA. Logistic regression was used to identify factors associated with bilateral THA. RESULTS Bilateral THA was performed in 67.3% (n=251) of the patients. Male patients had a higher frequency of undergoing bilateral THA compared with female ones (P<0.05). The proportion of the patients who had bilateral onset in hips, administration of TNF inhibitors, flexion contracture in the hip, and a BASRI-hip score of 4 was significantly higher in patients with bilateral THA than that with unilateral THA (P<0.05). Patients with bilateral THA experienced longer disease duration than those with unilateral THA (P<0.05). The results of the logistic regression showed that factors related to bilateral THA were bilateral onset in hips, administration of TNF inhibitors, a BASRI-hip score of 4, and an erythrocyte sedimentation rate (ESR) level (P<0.05). CONCLUSION Bilateral THA is more common in AS patients with advanced hip involvement. Bilateral onset in hips, a BASRI-hip score of 4, and a higher level of ESR are risk factors associated with bilateral THA, while anti-TNF therapy is a protective factor reducing the progression of hip involvement to bilateral THA.
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Affiliation(s)
- Liangliang Li
- Medical School of Chinese PLA, Beijing, People’s Republic of China
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
- Department of Orthopedics, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, People’s Republic of China
| | - Jun Fu
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Chi Xu
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Ming Ni
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Wei Chai
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Libo Hao
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Yonggang Zhou
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Jiying Chen
- Department of Orthopedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, People’s Republic of China
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George R, Chandy VJ, Christudoss AI, Hariharan TD, ArunShankar A, Antonisamy B, Oommen AT, Poonnoose PM. Peri-operative Morbidity Associated with Bilateral Hip Arthroplasty for Inflammatory Arthritis: Results from a Consecutive Series of 168 Hips. Indian J Orthop 2021; 55:1232-1239. [PMID: 34824724 PMCID: PMC8586095 DOI: 10.1007/s43465-021-00474-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/31/2021] [Indexed: 02/04/2023]
Abstract
AIM This study aims to assess the risks and peri-operative morbidity associated with a single-stage sequential bilateral hip arthroplasty (SBHA) when performed in patients with arthritis secondary to inflammatory arthropathy. METHODS Data of patients who underwent SBHA between 2012 and 2018 for inflammatory arthritis were extracted from a database, for peri-operative complications and functional improvement. SBHA for other causes was excluded. RESULTS Data of 84 consecutive patients with a mean age of 34.5 years were analyzed. The mean follow-up was 2.4 years. 66% had ankylosing spondylitis, while 14% had rheumatoid arthritis. 50% of the patients had bilateral fusion of the hips, and 34% had flexion deformity > 30°.None of the patients had peri-operative cardiac or pulmonary complications. 2.4% had per-operative hypotension (MAP < 50 mmHg) and 1.2% had desaturation (SpO2 < 90%). The mean drop in hematocrit was 9.3%. While 31% did not require blood transfusion, 35% required more than 1 unit of blood. Patients with pre-operative PCV of > 36% had a significantly lower risk of being transfused > 1 unit of blood (p = 0.02). ICU admission was 6%-mostly for post-operative monitoring. While one patient had a local hematoma that needed a wash-out, there were no infections, dislocations, or mortality in these patients. The modified Harris hip score improved from a mean of 26.5-85. The mean hip flexion improved post-operatively from 32° to 92°. CONCLUSIONS SBHA for inflammatory arthritis can be performed with minimum complications in a multidisciplinary setting. Pre-operatively, PCV of > 36 is advised to reduce transfusion rates.
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Affiliation(s)
- Rahul George
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - V. J. Chandy
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - A. I. Christudoss
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - T. D. Hariharan
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - A. ArunShankar
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - B. Antonisamy
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu 632002 India
| | - A. T. Oommen
- Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu 632004 India
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Mou P, Zeng WN, Chen Y, Zhou Z. Synchronous or sequential cementless bilateral total hip arthroplasty for osseous ankylosed hips with ankylosing spondylitis. BMC Musculoskelet Disord 2021; 22:302. [PMID: 33761925 PMCID: PMC7988988 DOI: 10.1186/s12891-021-04142-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 03/03/2021] [Indexed: 02/07/2023] Open
Abstract
Background Bilateral osseous ankylosed hips secondary to ankylosis spondylitis (AS) are relatively rare but impact the quality of life hugely. Cementless total hip arthroplasty (THA) for bilateral osseous ankylosed hips with AS is a challenging procedure. No previous literature compares the clinical outcomes of synchronous and sequential bilateral THA for these special patients. Methods 23 patients (46 hips) were retrospectively analyzed and divided into bilateral THA synchronously (group A) and sequentially (group B). The clinical measurement, radiological assessments, and complications were compared. Independent sample T test was used for data analysis. Results Harris Hip Scores (HHS) improved greatly for both groups (P = 0.58) as well as the range of motion (P = 0.64). But group B can realize shorter time (3.6 ± 1.2 days) to walk for the first time postoperatively (P = 0.02). Group A needed more blood transfusions (P = 0.028). For group A, no statistical difference was found in the bilateral inclination of cup (IC) (P = 0.48) and femoral offset (FO) (P = 0.07). For group B, no statistical difference was observed in bilateral IC (P = 0.37) but in bilateral FO (P = 0.04). Group A showed the fewer difference of bilateral IC (P = 0.02), while comparative measurements were found for two groups in the difference of bilateral FO (P = 0.78) and leg length discrepancy (P = 0.83). For both groups, the total hospital expense for each patient was similar and almost all patients were very satisfied with the outcomes. For group A, one patient encountered femoral fracture intraoperatively and another patient encountered hip dislocation and delay union of wound. 3 hips from group A and 3 hips from group B encountered heterotopic ossification. Conclusions Our retrospective research demonstrated that cementless bilateral THA was a reliable treatment for osseous ankylosed hip due to AS. Synchronous and sequential bilateral THA can realize similarly satisfactory clinical outcomes and radiographic evaluation.
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Affiliation(s)
- Ping Mou
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Road, 610041, Chengdu, People's Republic of China
| | - Wei Nan Zeng
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Road, 610041, Chengdu, People's Republic of China.,Department of Orthopedics, Chongqing General Hospital, University of Chinese Academy of Sciences, 400014, Chongqing, China
| | - Yu Chen
- Clinical medicine, West China Medical School, West China Hospital, Sichuan University, 610041, Chengdu, Sichuan Province, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, West China Hospital, Sichuan University, #37 Guoxue Road, 610041, Chengdu, People's Republic of China.
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14
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Han L, Quan R, Pei Z, Cao G, Hu Y, Liu J. Mid-term results of bilateral synchronous total hip arthroplasty for bony ankylosis in patients with ankylosing spondylitis. J Orthop Surg Res 2021; 16:104. [PMID: 33531039 PMCID: PMC7851917 DOI: 10.1186/s13018-021-02258-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/21/2021] [Indexed: 11/13/2022] Open
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.
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Affiliation(s)
- Lei Han
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, No. 152 Yucai Road, XiaoShan District, Hangzhou, 311201, Zhejiang Province, China
| | - Renfu Quan
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, No. 152 Yucai Road, XiaoShan District, Hangzhou, 311201, Zhejiang Province, China
| | - Zhenle Pei
- Department of Medical Center of Fudan University, No. 305 Fenglin Road, XuHui District, Shanghai City, 200433, Shanghai, China
| | - Guoping Cao
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, No. 152 Yucai Road, XiaoShan District, Hangzhou, 311201, Zhejiang Province, China
| | - Yungen Hu
- Department of Orthopaedics Institute, Xiaoshan Traditional Chinese Medical Hospital, No. 152 Yucai Road, XiaoShan District, Hangzhou, 311201, Zhejiang Province, China
| | - Jingjing Liu
- Department of Rheumatology and Immunology, The Third Affiliated Hospital of Zhejiang Chinese Medical University, No. 219 Moganshan Road, Xihu District, Hangzhou, 310005, Zhejiang Province, China.
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15
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Bilateral simultaneous total hip arthroplasty in ankylosed hips with and without computer navigation: a case report. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Li L, Fu J, Xu C, Guan H, Ni M, Chai W, Hao L, Zhou Y, Chen J. Factors associated with blood loss in ankylosing spondylitis patients with hip involvement undergoing primary total hip arthroplasty: a cross-sectional retrospective study of 243 patients. J Orthop Surg Res 2020; 15:541. [PMID: 33208176 PMCID: PMC7672842 DOI: 10.1186/s13018-020-02064-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 12/16/2022] Open
Abstract
Background Total hip arthroplasty (THA) can cause considerable blood loss and perioperative transfusion in ankylosing spondylitis (AS) patients. This study aimed to identify the factors related to blood loss in AS patients with hip involvement undergoing THA. Methods We analyzed 243 AS patients with advanced hip involvement undergoing primary THA from 2012 to 2017. Bilateral THA was performed by a one-stage operation during one general anesthesia session. The patients were divided into three groups according to the grade of blood loss, as determined by the Advanced Trauma Life Support hypovolemic shock classification system. Ordinal logistic regression was used to identify factors associated with blood loss in the patients. Results The proportion of patients who were male, underwent bilateral THA, had a hip range of motion (ROM) = 0°, had a BASRI-hip score of 4, underwent iliopsoas and adductor release, and underwent autologous or allogenic transfusion increased significantly with the grade of blood loss, while that of the patients who received tranexamic acid (TXA) decreased significantly (P < 0.05). The preoperative hemoglobin (Hb) level, hematocrit level, and operating time also increased significantly with the grade of blood loss (P < 0.05). The ordinal logistic regression results identified the factors related to blood loss during THA in AS patients with hip involvement to be the male sex (odds ratio [OR] = 3.287; 95% confidence interval [CI] 1.022, 10.567), bilateral THA (OR = 13.896; 95% CI 4.950, 39.011), hip ROM = 0° (OR = 2.513; 95% CI 1.277, 4.946), an elevated erythrocyte sedimentation rate (ESR) level (OR = 3.042; 95% CI 1.320, 7.014), an elevated preoperative Hb level (OR = 1.043; 95% CI 1.017, 1.070), a long operating time (OR = 1.009; 95% CI 1.003, 1.016), and the administration of TXA (OR = 0.252; 95% CI 0.134, 0.472). Conclusions The male sex, bilateral THA, a hip ROM = 0°, an elevated ESR level, a high preoperative Hb level, and a long operating time are risk factors associated with blood loss in AS patients with hip involvement undergoing THA, while the administration of TXA is a protective factor. These results might help determine the risk of bleeding in the perioperative assessment and develop more efficient blood management strategies for THA in AS patients with hip involvement.
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Affiliation(s)
- Liangliang Li
- Medical School of Chinese PLA, Beijing, China.,Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.,Department of Orthopaedics, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jun Fu
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Chi Xu
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Haitao Guan
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Ming Ni
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wei Chai
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Libo Hao
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
| | - Yonggang Zhou
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jiying Chen
- Department of Orthopaedics, The First Medical Centre, Chinese PLA General Hospital, Beijing, China.
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Man S, Ji X, Zhang L, Hu Z, Lv Y, Zhou Y, Song H, Huang F. Effects of types and degrees of ankylosing spondylitis hip structural damages on post-total hip arthroplasty outcome measurements. Medicine (Baltimore) 2020; 99:e23174. [PMID: 33181692 PMCID: PMC7668424 DOI: 10.1097/md.0000000000023174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
To determine the effects of ankylosing spondylitis (AS)-associated hip damages on the outcome measurements after total hip arthroplasty (THA).The medical records of 122 patients with AS (181 hips) who underwent THA were retrospectively reviewed. The mean follow-up was 43.9 (32-129) months. The types and degrees of hip damages were evaluated by preoperative hip X-rays. The patients were grouped according to the satisfaction degree after the operation. Univariable and multivariable statistical analyses were conducted.The intraclass correlation coefficients for the assessment between the 2 reviewers in the study were 0.86 to 0.97. Cox regression showed that femoral head erosion severity had an effect on the recovery time of independent walking without crutches postoperatively (odds ratio = 1.467, 95% confidence interval: 1.050-2.409, P = .025). The mean time to recover independent walking in the severe femoral head erosion group was 7.3 ± 0.9 weeks, which was 4.6 ± 0.4 weeks longer than in the non-severe femoral head erosion group, as confirmed by the log-rank (Mantel-Cox) test (Chi-squared = 11.684, P = .001). The multivariable analysis showed that higher acetabular sclerosis scores correlated with lower postoperative dissatisfaction risk (odds ratio = 0.322, 95% confidence interval: 0.136-0.764). The multiple linear regression analysis showed that postoperative range of motion (ROM) improvement was affected by preoperative ROM of the hip, space narrowing degree, and ceramic-ceramic material for the weight-bearing surface (F = 179.81, P < .001), with preoperative ROM of the hip having the greatest impact.Severe femoral head erosion prolongs the recovery time of independent walking after THA. Acetabular sclerosis is not associated with poor outcomes in patients with AS-associated hip damage undergoing THA.
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MESH Headings
- Acetabulum/diagnostic imaging
- Acetabulum/pathology
- Acetabulum/physiopathology
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/methods
- Arthroplasty, Replacement, Hip/rehabilitation
- China/epidemiology
- Female
- Femur Head/diagnostic imaging
- Femur Head/pathology
- Femur Head/physiopathology
- Hip Prosthesis
- Humans
- Male
- Middle Aged
- Osteoarthritis, Hip/complications
- Osteoarthritis, Hip/diagnosis
- Osteoarthritis, Hip/surgery
- Outcome Assessment, Health Care
- Radiography/methods
- Range of Motion, Articular
- Recovery of Function
- Retrospective Studies
- Severity of Illness Index
- Spondylitis, Ankylosing/complications
- Spondylitis, Ankylosing/diagnosis
- Treatment Outcome
- Walking
- Weight-Bearing
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Affiliation(s)
- Siliang Man
- Department of Rheumatology, Beijing JiShuiTan Hospital
| | - Xiaojian Ji
- Department of Rheumatology, Chinese PLA General Hospital
| | - Liang Zhang
- Department of Adult Joint Reconstructive Surgery
| | - Zhengyuan Hu
- Department of Rheumatology, Chinese PLA General Hospital
| | - Yanwei Lv
- Department of Clinical Epidemiology, Beijing JiShuiTan Hospital, Beijing, China
| | - Yixin Zhou
- Department of Adult Joint Reconstructive Surgery
| | - Hui Song
- Department of Rheumatology, Beijing JiShuiTan Hospital
| | - Feng Huang
- Department of Rheumatology, Chinese PLA General Hospital
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Kanniyan K, Patil S, Kumar PSA, Suryanarayan P, Bose VC. Does the Femoral Head Size Influence Outcomes After Uncemented Total Hip Arthroplasty for Fused Hips? A Prospective Study in Ankylosing Spondylitis. Indian J Orthop 2020; 54:831-839. [PMID: 33133406 PMCID: PMC7573063 DOI: 10.1007/s43465-020-00210-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Uncemented total hip arthroplasty (THA) with large size femoral heads have shown greater advantage with good stability, range of motion and decreased dislocation rate in ankylosing spondylitis (AS). Meticulous planning is needed to address the unique surgical challenges in such patients with fused hip and spinal deformity. MATERIALS AND METHODS Thirty fivefused hip joints in twenty-five AS patients who underwent uncemented THA (April 2014 to December 2016) were included in our prospective study and were followed up for a minimum period of 36 months. Pain relief, functional improvement and patient satisfaction were statistically assessed using "Visual Analogue Score" (VAS), "Harris Hip Score" (HHS) and "AJRI 10-Point Satisfaction Score" (A10PSS), respectively. RESULTS The overall mean preoperative VAS improved from 6.9 ± 1.5 to 1.5 ± 1, HHS improved from 50.0 ± 12 to 88.4 ± 7.8 and A10PSS improved from 2.2 ± 1.2 to 7.6 ± 0.8. Our study results were significant with zero dislocation and good functional score in comparison to the other available studies in literature. First subdivision study in AS patients with bilateral THA performed better than unilateral THA. Second subdivision study showed no significant statistical difference in terms of VAS, HHS, A10PSS and dislocation rate in relation to femoral head size between 32 mm, 36 mm and 40 mm. CONCLUSION Uncemented THA with large size femoral head equal or greater than 32 mm provides better stability and good functional outcome with less dislocation rate in comparison to older studies of literature with femoral head size less than 32 mm. LEVEL OF EVIDENCE A Level II study. (Data collected from the ongoing prospective study) (https://www.spine.org/Documents/LevelsofEvidenceFinal.pdf).
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Affiliation(s)
- Kalaivanan Kanniyan
- Asian Joint Reconstruction Institute (AJRI), SIMS Hospitals, Chennai, Tamil Nadu India
| | - Shantanu Patil
- Translational Medicine and Research, SRM Medical College, SRM IST, Kattankulathur, Tamil Nadu India
| | - P. S. Ashok Kumar
- Asian Joint Reconstruction Institute (AJRI), SIMS Hospitals, Chennai, Tamil Nadu India
| | - P. Suryanarayan
- Asian Joint Reconstruction Institute (AJRI), SIMS Hospitals, Chennai, Tamil Nadu India
| | - Vijay C. Bose
- Asian Joint Reconstruction Institute (AJRI), SIMS Hospitals, Chennai, Tamil Nadu India
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19
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Total Hip Arthroplasty in Untreated Ankylosing Spondylitis: Tips and Tricks to Avoid Complications. Tech Orthop 2020. [DOI: 10.1097/bto.0000000000000323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Malhotra R, Khurana A, Shekhar S, Gautam D. Proximal femoral fracture in ankylosed hip treated with primary total hip arthroplasty: Technical tips with report of two cases. J Clin Orthop Trauma 2020; 11:99-104. [PMID: 32001994 PMCID: PMC6985166 DOI: 10.1016/j.jcot.2019.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022] Open
Abstract
Proximal femoral fracture in an ankylosed hip is a challenging condition. There is no consensus on fixation method for these fractures. In addition, despite union the best outcome possible is the restoration of the pre morbid status. We report two different presentations of proximal femoral fracture in ankylosed hip that were successfully treated with primary total hip arthroplasty. We also discuss the surgical principles, technique and advantages of doing primary total hip arthroplasty in such cases.
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Abstract
Ankylosing Spondylitis (AS) can commonly involve the hip joint and cause significant mobility problems. Total hip arthroplasty (THA) on a single side alone will not restore mobility in patients with bilateral disease.We performed a systematic review of the available literature to determine the changes in objective outcome measures and complications of bilateral THA in patients with advanced AS. Four studies, a total of 114 THAs, were included in the study. The average patient age was 32.9 years and the average follow-up time was 59.5 months.All studies reported a significant improvement in hip function, patient satisfaction and patient mobility following bilateral THA. Harris Hip Score (HHS) improved by a mean of 60.6 points post-operatively.Complications included five intra-operative fractures (4.4%) and three transient nerve palsies (2.6%). There were two dislocations (1.8%) that were successfully managed with closed reduction. Seven hips required revision, with the most common cause being aseptic loosening. Twelve hips (10.5%) developed heterotopic ossification consistent with Brooker Class 1 or 2 with no reports of re-ankylosis.This review suggests that bilateral THA is a safe and effective treatment of advanced hip disease in AS. Attention must be paid to the highly demanding technical aspects of this procedure to reduce the risk of significant complications.Debate still exists on the ideal prosthesis, fixation method and approach to use but this review presents data from several series of uncemented prostheses that have good post-operative results. Cite this article: EFORT Open Rev 2019;4:476-481. DOI: 10.1302/2058-5241.4.180047.
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Affiliation(s)
- David Lin
- Trauma and Orthopaedic Surgery Department, Royal London Hospital, UK
| | | | - Sammy A Hanna
- Trauma and Orthopaedic Surgery Department, Royal London Hospital, UK
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Zhu W, He X, Cheng K, Zhang L, Chen D, Wang X, Qiu G, Cao X, Weng X. Ankylosing spondylitis: etiology, pathogenesis, and treatments. Bone Res 2019; 7:22. [PMID: 31666997 PMCID: PMC6804882 DOI: 10.1038/s41413-019-0057-8] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 05/20/2019] [Accepted: 05/23/2019] [Indexed: 02/06/2023] Open
Abstract
Ankylosing spondylitis (AS), a common type of spondyloarthropathy, is a chronic inflammatory autoimmune disease that mainly affects spine joints, causing severe, chronic pain; additionally, in more advanced cases, it can cause spine fusion. Significant progress in its pathophysiology and treatment has been achieved in the last decade. Immune cells and innate cytokines have been suggested to be crucial in the pathogenesis of AS, especially human leukocyte antigen (HLA)‑B27 and the interleukin‑23/17 axis. However, the pathogenesis of AS remains unclear. The current study reviewed the etiology and pathogenesis of AS, including genome-wide association studies and cytokine pathways. This study also summarized the current pharmaceutical and surgical treatment with a discussion of future potential therapies.
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Affiliation(s)
- Wei Zhu
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Xuxia He
- 2Department of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Kaiyuan Cheng
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Linjie Zhang
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Di Chen
- 3Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612 USA
| | - Xiao Wang
- 4Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Guixing Qiu
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
| | - Xu Cao
- 4Department of Orthopedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Xisheng Weng
- 1Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 100730 Beijing, China
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23
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Tam LS, Wei JCC, Aggarwal A, Baek HJ, Cheung PP, Chiowchanwisawakit P, Dans L, Gu J, Hagino N, Kishimoto M, Reyes HM, Soroosh S, Stebbings S, Whittle S, Yeap SS, Lau CS. 2018 APLAR axial spondyloarthritis treatment recommendations. Int J Rheum Dis 2019; 22:340-356. [PMID: 30816645 DOI: 10.1111/1756-185x.13510] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Despite the availability of axial spondyloarthritis (SpA) recommendations proposed by various rheumatology societies, we considered that a region-specific guideline was of substantial added value to clinicians of the Asia-Pacific region, given the wide variations in predisposition to infections and other patient factors, local practice patterns, and access to treatment across countries. MATERIALS AND METHODS Systematic reviews were undertaken of English-language articles published between 2000 and 2016, identified from MEDLINE using PubMed, EMBASE and Cochrane databases. The strength of available evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Recommendations were developed through consensus using the Delphi technique. RESULTS Fourteen axial SpA treatment recommendations were developed based on evidence summaries and consensus. The first 2 recommendations cover non-pharmacological approaches to management. Recommendations 3 to 5 describe the following: the use of non-steroidal anti-inflammatory drugs as first-line symptomatic treatment; the avoidance of long-term corticosteroid use; and the utility of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) for peripheral or extra-articular manifestations. Recommendation 6 refers to the indications for biological DMARDs (bDMARDs). Recommendation 7 deals specifically with screening for infections endemic to Asia, prior to use of bDMARDs. Recommendations 7 to 13 cover the role of bDMARDs in the treatment of active axial SpA and include related issues such as continuing therapy and use in special populations. Recommendation 14 deals with the utility of surgical intervention in axial SpA. CONCLUSION These recommendations provide up-to-date guidance for treatment of axial SpA to help meet the needs of patients and clinicians in the Asia-Pacific region.
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Affiliation(s)
- Lai Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Peter P Cheung
- Division of Rheumatology, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | | | - Leonila Dans
- Department of Pediatrics and Clinical Epidemiology, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Jieruo Gu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Noboru Hagino
- Division of Hematology and Rheumatology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Mitsumasa Kishimoto
- Immuno-Rheumatology Center, St Luke`s International Hospital, St Luke`s International University, Tokyo, Japan
| | - Heizel Manapat Reyes
- Division of Rheumatology, Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
| | - Soosan Soroosh
- AJA University of Medical Sciences, Rheumatology Research Center, Tehran, Iran
| | - Simon Stebbings
- Department of Medicine Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Samuel Whittle
- The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Malaysia
| | - Chak Sing Lau
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Ward MM. Complications of Total Hip Arthroplasty in Patients With Ankylosing Spondylitis. Arthritis Care Res (Hoboken) 2018; 71:1101-1108. [PMID: 29669197 DOI: 10.1002/acr.23582] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/10/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare the risks of complications of primary total hip arthroplasty (THA) between patients with ankylosing spondylitis (AS) and those without AS. METHODS In this population-based study, we examined data from 1999 to 2013 of US Medicare beneficiaries (ages <75 years old) with AS and a comparison group without AS who had undergone primary THA. Complications were based on the Centers for Medicare & Medicaid Services 2013 THA Complication Measure, which included myocardial infarction, pneumonia, or sepsis within 7 days; surgical site bleeding, pulmonary embolus, or venous thrombosis within 30 days; or mechanical complications or local infection within 90 days. Mortality within 90 days, revision arthroplasty within 1 year, long length of stay, discharge to a care facility, and readmission within 90 days were also examined. RESULTS The study included 2,773 patients with AS and 107,341 patients without AS who had THA. Perioperative complications, 30-day complications, and local infections were rare in both groups (<1%). Mechanical complications and revision arthroplasty were uncommon in both groups. Ninety-day mortality was lower among patients with AS than those without AS (0.36% versus 0.7%). Patients with AS were more likely to be discharged to a care facility, and slightly more likely to have a long length of stay. Likelihood of a long stay was lower at hospitals that performed ≥100 THAs per year, but other complications were not associated with hospital volume. CONCLUSION Complications after primary THA are uncommon in patients with AS and similar in frequency to those without AS. Ninety-day mortality was lower among patients with AS.
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Affiliation(s)
- Michael M Ward
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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25
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Yim SJ, Park YB, Kim J, Park SH. Long-term Outcomes of Cemented Total Hip Arthroplasty in Patients with Ankylosing Spondylitis at a Minimum Follow-up of 10 Years. Hip Pelvis 2018; 30:175-181. [PMID: 30202752 PMCID: PMC6123511 DOI: 10.5371/hp.2018.30.3.175] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose This study was performed to evaluate long-term clinical and radiologic outcomes of cemented total hip arthroplasty in patients with ankylosing spondylitis. Materials and Methods A retrospective study of 12 patients (16 cases) diagnosed with ankylosing spondylitis undergoing total hip arthroplasty with cemented femoral stem from November 2002 to January 2006 with a minimum follow up of 10 years. Clinical outcomes were assessed using Harris Hip Scores and measures of pain and range of motion. Radiologic outcomes were assessed with serial plain X-ray. Fixation and stability of implant, enthesopathy of ischium and development of heterotopic ossification were also evaluated. Results Mean Harris Hip Scores significantly improved from pre-operative levels (58 points; range, 39–81 points) to post-operative (92 points; range, 68–100 points). Mean flexion contracture levels decreased from preoperative (13°) to post-operative (5°), and mean post-operative range of motion improved 106° compared to preoperative levels. No newly developed osteolysis lesions or implant loosening were observed in last follow up X-rays. One heterotopic ossification and one greater trochanter fracture were observed. Greater trochanter fracture was treated conservatively, and was resulted in bony union. No patients underwent revisions. Conclusion This study revealed positive long-term clinical and radiologic outcomes following total hip arthroplasty with cemented femoral stems in patients with ankylosing spondylitis patients.
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Affiliation(s)
- Soo Jae Yim
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Yong Bok Park
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Junyoung Kim
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sin Hyung Park
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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26
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Malhotra R, Gautam D, Garg B, Trikha A. Simultaneous Quadruple Joint Replacement (QJR) in Disabling Juvenile Rheumatoid Arthritis - a Case Report with Review of Literature. THE ARCHIVES OF BONE AND JOINT SURGERY 2018; 6:243-247. [PMID: 29911143 PMCID: PMC5990718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/03/2017] [Indexed: 06/08/2023]
Abstract
We wish to present a case of 47-year-old patient with Juvenile Rheumatoid Arthritis and ankylosis of both hips and both knees treated by bilateral hip and knee arthroplasty in a single anaesthesia i.e. Quadruple joint replacement in single sitting. He was back on his feet from his bed-ridden state within the fortnight following surgery. He has been followed up for four years and has been performing his activities of daily living independently. We discuss the preoperative planning, surgical details and post-operative rehabilitation and unique challenges pertaining to this case.
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Affiliation(s)
- Rajesh Malhotra
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Deepak Gautam
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Bhavuk Garg
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Anjan Trikha
- All India Institute of Medical Sciences (AIIMS), New Delhi, India
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27
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Feng DX, Zhang K, Zhang YM, Nian YW, Zhang J, Kang XM, Wu SF, Zhu YJ. Bilaterally Primary Cementless Total Hip Arthroplasty for Severe Hip Ankylosis with Ankylosing Spondylitis. Orthop Surg 2017; 8:352-9. [PMID: 27627719 DOI: 10.1111/os.12254] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 06/23/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Total hip arthroplasty is a reliable therapeutic intervention in patients with ankylosing spondylitis, in whom the aims of surgery are to reduce pain, restore hip function and improve quality of life. The current study is a retrospective analysis of the clinical and radiographic findings in a consecutive series of patients with hip ankylosis associated with severe ankylosing spondylitis who underwent bilateral primary total hip arthroplasty using non-cemented components. METHODS From June 2008 to May 2012, total hip arthroplasty was performed on 34 hips in 17 patients with bilateral ankylosis caused by ankylosing spondylitis. The study patients included 13 men and 4 women with a mean age of 24.2 years. The mean duration of disease was 8.3 years and the average duration of hip involvement was 7.6 years. All patients had severe hip pain and dysfunction with bilateral bony ankylosis and no range of motion preoperatively and all underwent bilateral cementless total hip arthroplasty performed by a single surgeon. Joint pain, range of motion (ROM), and Harris hip scores were assessed to evaluate the postoperative results. RESULTS At a mean follow-up of 31.7 months, all patients had experienced significant clinical improvement in function, ROM, posture and ambulation. At the final follow-up, the mean postoperative flexion ROM was 134.4° compared with 0° preoperatively. Similar improvements were seen in hip abduction, adduction, internal rotation and external rotation. Postoperatively, 23 hips were completely pain-free, six had only occasional discomfort, three mild to moderate pain and two severe pain. The average Harris Hip Score improved from 23.7 preoperatively to 65.8 postoperatively. No stems had loosened at the final follow-up in any patient, nor had any revision surgery been required. CONCLUSIONS Bilateral severe hip ankylosis in patients with ankylosing spondylitis can be treated with cementless bilateral synchronous total hip arthroplasty, which can greatly improve hip joint function and relieve pain without significant complications. Provided the overall physical condition of a patient and their economic situation make surgery a feasible option and the surgeon is experienced, this treatment is a worthwhile surgical intervention for bilateral hip bony ankylosis. However, the technically demanding nature of the procedure and potential pre- and post-operative problems should not be underestimated.
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Affiliation(s)
- Dong-Xu Feng
- Department of Orthopaedics, School of Medicine, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xían, Shaanxi, China.,Center for Translational Medicine, the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China
| | - Kun Zhang
- Department of Orthopaedics, School of Medicine, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xían, Shaanxi, China
| | - Yu-Min Zhang
- Department of Orthopaedics, School of Medicine, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xían, Shaanxi, China
| | - Yue-Wen Nian
- Department of Orthopaedics, School of Medicine, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xían, Shaanxi, China
| | - Jun Zhang
- Department of Orthopaedics, School of Medicine, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xían, Shaanxi, China
| | - Xiao-Min Kang
- Center for Translational Medicine, the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China
| | - Shu-Fang Wu
- Center for Translational Medicine, the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine, Xi'an, Shaanxi, China.
| | - Yang-Jun Zhu
- Department of Orthopaedics, School of Medicine, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xían, Shaanxi, China.
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28
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Xu J, Zeng M, Xie J, Wen T, Hu Y. Cementless total hip arthroplasty in patients with ankylosing spondylitis: A retrospective observational study. Medicine (Baltimore) 2017; 96:e5813. [PMID: 28121928 PMCID: PMC5287952 DOI: 10.1097/md.0000000000005813] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Controversies on the surgical protocols and efficacies of total hip arthroplasty (THA) in ankylosing spondylitis (AS) still exist. The aim of this study was to retrospectively analyze the perioperative managements and their outcomes related to performing THA on patients with AS.Data of 54 AS patients who underwent 81 THAs between 2008 and 2014 were retrospectively analyzed. Clinical and imaging data were collected preoperatively, postoperatively, and during the follow-up period for surgical efficacy.Using posterolateral approach, cementless prostheses were selected in all cases. Mean follow-up period was 3.6 years (range, 2-8 years). Inclinations and anteversions of acetabular cups were 36.3°±4.5° (range, 30°-50°) and 12.3°±4.9° (range, 0°-25°) respectively. Mean visual analog scale (VAS) score decreased from 6.7 ± 2.1 (range, 4-10) preoperatively to 1.5 ± 1.0 (range, 0-4) at final follow-up, and mean Harris hip score (HHS) improved from 31.2 ± 11.6 (range, 15-45) to 86.1 ± 4.3 (range, 80-95) (P < 0.05). Postoperative range of motion (ROM) in flexion was improved from 6.7°±13.5° (range, 0°-50°) preoperatively to 82.5°±6.4° (range, 70°-100°) at final follow-up, and ROM in extension was improved from 1.8°±5.7°(range, 0°-15°) to 15.4°±2.6° (range, 10°-20°) (P < 0.05). Heterotopic ossification (HO) was documented in 9 hips (11.1%). Signs of stable fibrous ingrowth and bone ingrowth were detected in 52 and 29 hips, respectively. Sciatic never injury was occurred in 3 cases, and treated conservatively. There were no signs of periprosthetic fractures, dislocation, or prosthesis loosening.Surgical efficacies of THA for AS patients with severe hip involvement are satisfactory.
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Affiliation(s)
- Jun Xu
- Department of Orthopedics, Seventh People's Hospital of Shenzhen, Shenzhen, Guangdong
| | - Min Zeng
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Xie
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ting Wen
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
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29
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Mohanty SS, Mishra N, Patil P, Desale A. Functional Evaluation of Patients Undergoing Multiple Joint Replacements: A Retrospective Study of 50 Patients with a Minimum of Six Months of Follow-up. Cureus 2016; 8:e830. [PMID: 27896037 PMCID: PMC5111964 DOI: 10.7759/cureus.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Polyarthritis is a challenging condition that an orthopedic surgeon faces in day-to-day practice. Some of the conditions where multiple joints are affected are rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis. Multiple joint afflictions can cause severe impairment in the quality of life, which leads to a significant socioeconomic burden on the family and society. Joint replacement is considered as a treatment when severe joint pain or dysfunction is not alleviated by conservative management. Total joint arthroplasty remains one of the most commonly performed and universally accepted operative interventions for such patients. Materials and methods: Fifty patients were invited into the study. All patients included in the study were 18 years of age and older and had undergone two or more joint replacements with a minimum of six months duration from the last surgery. The data was collected during the preoperative and postoperative periods through patient records and questionnaires. The Short Form 36 Health Survey Questionnaire (SF-36) scores were generated from an online application that is readily available on the official website SF-36 scoring system. The results were compared, analyzed, and tested for significance using the Wilcoxon signed rank test. Results: The highest incidence of multiple joint replacements appears to be in the age-group of 51 - 70 years (52%), the mean age of patients being 51.7 +/- 14.4 years. The ratio of female to male patients was 1.6:1. On comparison of preoperative and postoperative (six months) physical component and mental component scores, the differences were found to be significant (p-value: < 0.01). This finding is irrespective of the diagnosis, gender, or age of the patient. Conclusion: In the study conducted on 50 patients, we found out that multiple joint arthroplasties are fruitful surgeries. The procedures are efficient in reducing the disabilities seen in patients with polyarthritis of various causes and improving the overall quality of life. We strongly recommend multiple joint arthroplasties to patients with severe disability. However, adequate medical management plays an equally important role to improve the overall results. Well-designed and larger studies are required to establish the treatment protocols and order of surgeries in patients with differing causes of polyarthritis.
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Affiliation(s)
- Shubhranshu S Mohanty
- Professor & Unit Head, Department of Orthopaedics, Seth GS Medical College & KEM Hospital, Mumbai, India
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30
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Li J, Zhao J, He C, Tong W, Zou Y, Xu W. Comparison of Blood Loss After Total Hip Arthroplasty Between Ankylosing Spondylitis and Osteoarthritis. J Arthroplasty 2016; 31:1504-9. [PMID: 27006146 DOI: 10.1016/j.arth.2015.12.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/12/2015] [Accepted: 12/17/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study was conducted to compare the blood loss during primary total hip arthroplasty (THA) between ankylosing spondylitis (AS) and hip osteoarthritis (OA). METHODS We reviewed 120 THAs in 68 patients comprising 3 groups: AS with total bony ankylosis of the hips (ASB), AS with stiff hips (ASS), and OA. Demographics, perioperative laboratory values, intraoperative data, blood loss, transfusion rate, transfusion reactions, surgical complications, hospitalization cost, and length of stay (LOS) were collected and analyzed among ASB, ASS, and OA groups. RESULTS The patients of the ASB and ASS groups were much younger and thinner than those of the OA group. There were no significant differences in the preoperative values of activated partial thromboplastin time, prothrombin time, and international normalized ratio among the 3 groups (all P > .05). The intraoperative blood loss, volume of drainage, hidden blood loss, transfusion rate, transfusion reactions, and hospitalization cost in the ASB group were significantly higher than in the other 2 groups, although not significantly different between the ASS and OA groups (P > .05). CONCLUSION Both AS and OA can cause hyperosteogeny to the hips, but ASB patients have more serious symptoms in their affected hips. This may cause more blood loss in THA surgery because of bone surface bleeding. The reason that ASB patients suffered more blood loss may be related to the high difficulty and long duration of the operation.
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Affiliation(s)
- Jia Li
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Jinzhu Zhao
- Department of Orthopedics, No. 401 Hospital, Jinan Military Region of PLA, Qingdao, Shandong, China
| | - Chongru He
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Wenwen Tong
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Yuming Zou
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Weidong Xu
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
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31
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Putnis SE, Wartemberg GK, Khan WS, Agarwal S. A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome. Open Orthop J 2015; 9:483-8. [PMID: 26587066 PMCID: PMC4645831 DOI: 10.2174/1874325001509010483] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/14/2015] [Accepted: 05/22/2015] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis is a spondyloarthropathy affecting the sacro-iliac joints with subsequent progression to the spine and the hip joints. The hip joints are affected by synovitis, enthesial inflammation, involvement of medullary bone, progressive degeneration and secondary osteoarthritis. Clinical presentation is usually in the form of pain and stiffness progressing to disabling fixed flexion contractures and in some instances, complete ankylosis. Hip arthroplasty should be considered for hip pain, postural and functional disability, or pain in adjacent joints due to hip stiffness. We conducted a literature review to determine peri-operative considerations and outcome in ankylosing spondylitis patients undergoing hip arthroplasty. In this review, we have discussed pre-operative surgical planning, thromboprophylaxis, anaesthetic considerations and heterotopic ossification. Outcomes of arthroplasty include range of movement, pain relief, survivorship and complications.
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Affiliation(s)
- S E Putnis
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - G K Wartemberg
- Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - W S Khan
- University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, Middlesex, HA7 4LP, UK
| | - S Agarwal
- Cardiff & Vale Orthopaedic Centre, Llandough University Hospital, Cardiff & Vale NHS Trust, Cardiff, CF5 2LD, UK
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32
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Wang W, Huang G, Huang T, Wu R. Bilaterally primary cementless total hip arthroplasty in patients with ankylosing spondylitis. BMC Musculoskelet Disord 2014; 15:344. [PMID: 25306112 PMCID: PMC4198795 DOI: 10.1186/1471-2474-15-344] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/06/2014] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to document the clinical and radiographic results of a consecutive series of patients with ankylosing spondylitis (AS) who had undergone bilaterally primary THA using non-cemented components. Methods Twenty-six hips of 13 patients with bilateral ankylosis of the hip caused by AS were converted to THA from January 2000 to January 2008. The mean age of the patients was 33.7 years (range, 22-57 years). There were 11 males and 2 females. All the patients had bilateral bony ankylosis with 0° range of motion. The average Harris Hip Scores (HSS) was 22.1 (10–38). Results At a mean follow-up of 128.4 months, the mean HSS at the latest follow-up examination was 91.7 points (range, 75-98 points). All the patients reported marked relief of painful symptoms. Three (11.5%) of the 26 hips were outside the Lewinnek acetabular cup inclination safe range, and 5 (19.2%) of the 26 hips were outside the Lewinnek acetabular cup anteversion safe range. The probability of survival of the prostheses was 100% at 5 years and 92.3% at 10 years, but it dropped sharply to 73.1% at 13 years. Conclusion Cementless THA is a worthwhile treatment for the osseous ankylosed hip joint caused by AS. Newfound mobility, maneuverability, and improved ability to sit comfortably were the outcomes that alleviated the patients’ daunted morale. However, the technically demanding nature of the procedure should not be underestimated. Electronic supplementary material The online version of this article (doi:10.1186/1471-2474-15-344) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wanchun Wang
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P R China.
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Ye C, Liu R, Sun C, Lin J, Li H, Re H, Sun B, Sun Q, Yang L. Cementless bilateral synchronous total hip arthroplasty in ankylosing spondylitis with hip ankylosis. INTERNATIONAL ORTHOPAEDICS 2014; 38:2473-6. [PMID: 25030965 DOI: 10.1007/s00264-014-2461-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE This study was a retrospective analysis of early and mid-term clinical effects and perioperative management of cementless bilateral synchronous total hip arthroplasty (THA) in patients with ankylosing spondylitis (AS) with bilateral hip ankylosis. METHODS Fifteen AS patients (30 hips) with bilateral hip ankylosis were managed with cementless bilateral synchronous THA. Surgical outcome was evaluated using the visual analogue scale (VAS), the range of motion and the Harris score. RESULTS The mean follow-up period was 29.3 months. At the last follow-up visit, the VAS score decreased from 7.53 ± 0.99 before the operation to 2.40 ± 0.91. The Harris score increased from 24.8 ± 7.42 before the operation to 83.8 ± 4.61. The total range of motion increased from 78.73 ± 14.53 before the operation to 209.73 ± 16.19 after the operation. After the operation, there was one case of early hip dislocation, one case of femoral nerve stretch injury and one case of superficial incision infection. There were no cases of deep venous thrombosis. X-ray examinations did not show prosthetic loosening or displacement. CONCLUSION AS patients with bilateral hip ankylosis can be treated with cementless bilateral synchronous THA, which could greatly improve hip joint function without significant complications. The clinical effects proved to be satisfactory.
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Affiliation(s)
- Chuan Ye
- Department of Orthopaedics, The Affiliated Hospital of Guiyang Medical College, Guiyang, 550004, China,
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Zhang L, Yang D, Yin X, Zhou Y. Risk factors for poor hip flexion after total hip arthroplasty for the treatment of ankylosing spondylitis a multivariate analysis. Clin Rheumatol 2014; 33:1295-301. [PMID: 24651916 DOI: 10.1007/s10067-014-2575-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 02/23/2014] [Accepted: 03/05/2014] [Indexed: 11/25/2022]
Abstract
The purpose of this study is to investigate the clinical and radiographic results of total hip arthroplasty (THA) for the treatment of ankylosing spondylitis (AS) and to evaluate the effects of patient, prosthesis design, and surgical technique-related risk factors on postoperative functional results. We retrospectively reviewed the clinical and radiographic results of THA performed in 167 hips for 100 patients with AS. The average follow-up period was 54.8 months (range, 32-129 months). The hip passive-flexion arc averaged only 0 ° (0-40.0 °) before surgery, compared with 100.0 ° (85.0-110.0 °) at the most recent follow-up examination (P < 0.001). Multivariate regression demonstrated that significant variables for postoperative hip flexion were degree of preoperative flexion contracture, preoperative level of C-reactive protein, use of a 32-mm femoral head, and postoperative heterotopic ossification. In patients with AS with severe pain, limited motion and posture, as well as deformity, the overall outcomes after THA were found to be favorable with an encouraging midterm prosthetic survivorship, a low complication rate and a high level of patients' satisfaction. It seemed these patients were particularly predisposed to relative poor range of motion of the involved hips after THA which was closely related to patients' satisfaction. The surgeons should pay careful attention to all possible risk factors perioperatively and develop a comprehensive treatment regimen.
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Affiliation(s)
- Liang Zhang
- Department of Adult Joint Reconstructive Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, Jishuitan Orthopaedic College of Tsinghua University, 31 East Xinjiekou Street, Beijing, 100035, China
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Siavashi B, Mohseni N, Zehtab MJ, Ramim T. Clinical outcomes of total hip arthroplasty in patients with ankylosed hip. THE ARCHIVES OF BONE AND JOINT SURGERY 2014; 2:25-30. [PMID: 25207309 PMCID: PMC4151429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 02/23/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hip ankylosis includes the limitation of hip motion and hip arthroplasty is the recommended treatment. This study aimed to evaluate the clinical and radiographic outcomes in the treatment of ankylosis of the hip joint by the Harris Hip Score (HHS). METHODS This interventional study was performed on patients with ankylosis in one or both hip joints, who were referred to Sina Hospital, Tehran, Iran from 2011-13. Electromyogram and nerve conduction studies were taken from the hip abductor muscles before surgery and HHS was calculated. Type of surgery and prosthesis, osteotomy required for the neck and trochanteric region of the femur, periprosthetic fracture and the need to restore the acetabulum were studied in the patients. Postoperative complications such as infection and dislocation at 3, 6 and 12 months after surgery were examined and then the HHS was calculated. RESULTS Six patients were excluded after six month and two patients were excluded after 12 month due to surgery complications. The mean HHS of patients before surgery was 48.53±6.28 and it progressed to 88.22±3.78 after 12 month (P<0.001). CONCLUSIONS Total hip arthroplasty for patients with ankylosed hip can improve the range of joint motion, especially in the long-term follow-up. However, good results should be considered in the absence of pre- and post-operative complications.
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Affiliation(s)
- Babak Siavashi
- Babak Siavashi MD, Mohammad Javad Zehtab MD, Nima Mohseni MD, Department of Orthopedics, Sina hospital Tehran University of Medical Sciences, Tehran, Iran
| | - Nima Mohseni
- Babak Siavashi MD, Mohammad Javad Zehtab MD, Nima Mohseni MD, Department of Orthopedics, Sina hospital Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad J Zehtab
- Babak Siavashi MD, Mohammad Javad Zehtab MD, Nima Mohseni MD, Department of Orthopedics, Sina hospital Tehran University of Medical Sciences, Tehran, Iran
| | - Tayeb Ramim
- Babak Siavashi MD, Mohammad Javad Zehtab MD, Nima Mohseni MD, Department of Orthopedics, Sina hospital Tehran University of Medical Sciences, Tehran, Iran
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Li J, Wang Z, Li M, Wu Y, Xu W, Wang Z. Total hip arthroplasty using a combined anterior and posterior approach via a lateral incision in patients with ankylosed hips. Can J Surg 2013; 56:332-40. [PMID: 24067518 DOI: 10.1503/cjs.000812] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND For most patients with severely ankylosed hips, traditional surgical approaches do not provide sufficient exposure during THAs. We report our experience with a combined anterior and posterior approach using a lateral incision for total hip arthroplasty (THA) in patients with severe, spontaneous bony hip ankylosis. METHODS Between January 2004 and December 2008, patients with severe, spontaneous bony hip ankylosis underwent THA via a combined anterior and posterior approach using a lateral incision. RESULTS We included 47 patients (76 hips) with a mean age of 53 (range 22-72) years in our study. All surgeries were successful, and no significant postoperative complications occurred. The mean operative duration was 1.5 (range 1.3-1.7) hours, and mean blood loss was 490 (range 450-580) mL. The mean duration of follow-up was 5.5 (range 2-11) years. Harris hip score improved from 53 to 88 points postoperatively, and the outcome was good to excellent in 88.37% of cases. Heterotopic ossification occurred in 6 hips, and infection, which resolved with antibiotics, occurred in 1 patient. CONCLUSION This combined anterior and posterior approach to THA using a lateral incision in patients with severe, spontaneous ankylosis provides very good exposure, protects the abduction unit and results in good to excellent postoperative recovery.
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Affiliation(s)
- Jian Li
- From the Department of Orthopedics, the Second Military Medical University Changhai Hospital and the Department of Orthopedics, Hainan Division of General Hospital of PLA, Sanya, China
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Romagnoli S, Zacchetti S, Perazzo P, Verde F, Banfi G, Viganò M. Simultaneous bilateral total hip arthroplasties do not lead to higher complication or allogeneic transfusion rates compared to unilateral procedures. INTERNATIONAL ORTHOPAEDICS 2013; 37:2125-30. [PMID: 23881063 PMCID: PMC3824890 DOI: 10.1007/s00264-013-2015-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 06/26/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE About 20 % of patients undergoing a primary total hip arthroplasty could undergo a second contralateral procedure within five years. The possibility to perform simultaneous bilateral hip replacements instead of two-stage surgery could reduce hospitalisation time and patient management costs, but concerns exist because of risks related to massive blood loss and possible increase in complication rates. The purpose of this study is to assess the veracity of these concerns. METHODS Parameters like blood loss, transfused blood units, total hospital length of stay (surgical and rehabilitation) and presence of in-hospital complications were collected from surgery reports of two different groups of patients. The first group comprised patients undergoing simultaneous bilateral total hip arthroplasty (n = 63), while the second group consisted of patients undergoing unilateral surgery (n = 97). Occurrence of complications within six post-operative months was assessed by phone interview. RESULTS No differences were observed in complication, revision and mortality rates between the study groups. On the contrary, blood loss was significantly higher in the bilateral group, but the application of appropriate transfusion protocols reduced the use of allogeneic blood transfusion to the levels recorded for unilateral patients. Moreover, the difference in length of hospital stay (about two days) between the two groups was not clinically relevant. CONCLUSIONS Our data show that simultaneous bilateral procedures do not lead to higher complication or allogeneic transfusion rates in comparison to unilateral hip replacement, and that, in cases of bilateral disease, they could significantly reduce the total length of hospital stay and, therefore, patient management costs.
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Affiliation(s)
- Sergio Romagnoli
- />IRCCS Galeazzi Orthopaedic Institute, via R. Galeazzi 4, 20161 Milan, Italy
| | - Sara Zacchetti
- />IRCCS Galeazzi Orthopaedic Institute, via R. Galeazzi 4, 20161 Milan, Italy
| | - Paolo Perazzo
- />IRCCS Galeazzi Orthopaedic Institute, via R. Galeazzi 4, 20161 Milan, Italy
| | - Francesco Verde
- />IRCCS Galeazzi Orthopaedic Institute, via R. Galeazzi 4, 20161 Milan, Italy
| | - Giuseppe Banfi
- />IRCCS Galeazzi Orthopaedic Institute, via R. Galeazzi 4, 20161 Milan, Italy
- />Department of Biomedical Sciences for Health, University of Milan, via R. Galeazzi 4, 20161 Milan, Italy
| | - Marco Viganò
- />IRCCS Galeazzi Orthopaedic Institute, via R. Galeazzi 4, 20161 Milan, Italy
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Guan M, Wang J, Zhao L, Xiao J, Li Z, Shi Z. Management of hip involvement in ankylosing spondylitis. Clin Rheumatol 2013; 32:1115-20. [DOI: 10.1007/s10067-013-2278-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 04/19/2013] [Indexed: 01/26/2023]
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e31827525d3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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