A Literature Review of Total Hip Arthroplasty in Patients with Ankylosing Spondylitis: Perioperative Considerations and Outcome

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.

Spine–hip relations in patients with hip osteoarthritis

“… 10 , 17 , 37 , 38 This relates to the concept of kinematically aligned total hip arthroplasty (KA THA), which has recently been promoted by Riviere et al 10 In contrast with the attractive but costly optimized positioning system® (Corin, Cirencester, UK), 39 , 40 the authors suggest a simple, low-cost and fast way to achieve patient-specific implant positioning by defining the optimal acetabular cup design and orientation based on the individual SHR. 10 In order to improve the positioning of the cup, the surgeon must first pre-operatively define an optimal cup orientation 7 , 11 , 18 , 41 , 42 based on the assessment of the individual dynamic functional acetabular orientation, 36 , 37 and second, intra-operatively precisely position the acetabular cup, ideally by simply using the transverse acetabular ligament (TAL). Aligning the cup with the TAL has been shown to be clinically safe and effective 43 and to lead to better standing cup orientation, 44 even in cases of hip dysplasia.…”

Ankylosing spondylitis does not increase the risk of neurogenic heterotopic ossification in patients with a spinal cord injury: a retrospective cohort study

“…The prevalence of HO in AS patients seems to be decreasing over time, 15 with the HO prevalence in AS patients following THA reported in 1967 as 62%, whereas in 2012, the prevalence was reported as 6.4%. As discussed by the authors, evolving surgical techniques, such as minimally invasive procedures, or innovations in implant design, may have helped lower the incidence of HO after THA.…”

Spondyloarthritis is associated with higher healthcare utilization and complication rates after primary total knee or total hip arthroplasty

“…While patient-reported pain and function outcomes post-THA/TKA in SpA are similar to the general population 11 years post-TKA [4] and 2 years post-THA [5], healthcare utilization and complication rates differ. Compared with people with OA or the general population, AS was associated with higher 90-day readmission rates and complications post-TKA [6] and more complications [7] and longer hospital stay and more discharges to a care facility post-THA [8].…”