Hip Replacement in Patients with Ankylosing Spondylitis

Abstract

Hip involvement in Ankylosing spondylitis (AS) patients with preexisting spinal deformity further compromises their posture and limits their mobility. Although medical management has improved the outcome and may have reduced the need for surgery, orthopedic surgery and in particular Total Hip Arthroplasty (THA) is often required to manage pain and restore function and mobility.THA remains the most effective treatment strategy to relieve pain and improve ambulatory status in these patients. However many important considerations regarding preoperative evaluation and surgical technique must be taken into account in order to improve the results of THA in this subgroup of patients.

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

“…THA in stiff hips with AS have fixed deformities[ 23 ]. Flexion deformity is the most common[ 3 , 10 , 11 ], and an extension abduction deformity occurs rarely[ 24 ]. External rotation deformities also coexist indicating contracture of the internal rotators and posterior capsule.…”

“…Re-ankylosis has also been reported with significant HO following THA in AS associated with a reduced range of movement. Trochanteric osteotomy approach has been attributed to increased incidence of HO and re-ankylosis in earlier reports[ 3 , 11 , 57 ]. HO following THA in AS is probably due to chronic inflammation seen in the joint as well as the surrounding tissues with varying degrees of stiffness.…”

Total hip arthroplasty for neglected bed ridden case of ankylosing spondylitis - A case report

“…Ankylosing spondylitis (AS) is a progressive chronic inflammatory autoimmune disease characterized by widespread spondylitis and sacroiliitis, mediated by CD8 T cells. 1,2 The worldwide prevalence of AS is 1 to 1.4% 3 affecting males 3 times more than females 4 specially young adults (2 nd to 3 r d decade of life) with positive HLA-B-27. 5 It primarily appears as axial spondyloarthropathy affecting the sacroiliac joints and spine and hips.…”