The effects of total hip arthroplasty in treating hip bony fusion in young and middle-aged patients with ankylosing spondylitis

Clinical effects of direct anterior internal fixation with Herbert screws on hip joint function and quality of life in patients with Pipkin II femoral head fractures

OBJECTIVE

The study aimed to explore the therapeutic effects of direct anterior internal fixation with Herbert screws on hip joint function and quality of life in patients with Pipkin type II femoral head fractures (FHF).

METHODS

From Dec 2017 to Jul 2020, 68 patients with Pipkin type II FHF were received in our hospital and divided into two groups. The direct anterior internal fixation (DAIF) group including 34 cases were treated by direct anterior internal fixation with Herbert screws. The control group of 34 patients received modified internal fixation with Herbert screws via posterior superior iliac spine and ectogluteus. The duration time and blood loss in operation as well as the postoperative drainage volume, hospital stays and complications were observed. The comparison of pain degree, hip functions, and life quality between two groups was performed.

RESULTS

All the patients were followed up, and the operative time, intraoperative blood loss, postoperative drainage and hospital stay of the DAIF group were all significantly lower than those in the control group, with (p < 0.05, respectively). The pain degree of the DAIF group was significantly lower than that of the control group 7, 15 and 30 days after the operation (p < 0.05, respectively). At 3, 6 and 9 months after the operation, the hip function recovery of the DAIF group was significantly better than control group (p < 0.05). There were no significant differences between the two groups in preoperative physiological function, physiological function, emotional role, physical pain, general health, vitality, social function and mental health (p > 0.05). Six months after the operation, the physiological function, physiological function, emotional role, physical pain, general health, vitality, social function and mental health of the DAIF group were significantly higher than those of the control group (p < 0.05). No postoperative complications occurred in both groups.

CONCLUSION

The treatment of directly anterior internal fixation with Herbert screws is effective for Pipkin type II FHF, like improving the function of hip joint and quality of life in patients. The method is reliable and worth clinical use.

Fourth‐Generation Ceramic‐on‐Ceramic THA in Patients with Ankylosing Spondylitis: A Minimum 10‐Year Follow‐Up

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.

Total hip arthroplasty in fused hips with spine stiffness in ankylosing spondylitis

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.

Synchronous or sequential cementless bilateral total hip arthroplasty for osseous ankylosed hips with ankylosing spondylitis

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.

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

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.

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

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.

Total hip arthroplasty and lumbar spine disorders: Plain co-existence or mutual influence?

Lumbar spine disorders (LSD) might influence the outcome after total hip arthroplasty (THA). Despite a known common prevalence of LSD and degenerative hip disorders, this study investigates their mutual influence in case of co-existence with the purpose to advance surgeons planning and patient’s prognosis. Patients with and without LSD were compared before and at the one-year postoperative examination. For clinical evaluation the WOMAC was assessed. The radiological analysis focused on cup anteversion and inclination. The total group included 203 consecutive patients. The overall incidence of LSD was 51.0%. Patients with LSD were on average 4.3 years older and had a 1.8 higher BMI than non-LSD patients (P<0.05). The cup positioning and the clinical results were comparable between both groups before and at the last time of follow up (P>0.05). No hip dislocations nor clinical signs of impingement were seen.We can conclude that there is a high degree of co-existence of LSD and hip disorders. However, a strong negative impact of LSD to clinical or radiologic results could not be confirmed in our study.