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

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.

Hypotensive Anesthesia Combined with Tranexamic Acid Reduces Perioperative Blood Loss in Simultaneous Bilateral Total Hip Arthroplasty: A Retrospective Cohort Study

“…Nevertheless, the hemorrhage during SBTHA can be enormous. It is estimated that postoperative anemia develops in about 90% of patients after SBTHA, and the overall allogeneic transfusion rate can be up to 49.3%-72.7%, leading to a significant increase in morbidity, transfusion-related complications, and economic burden [5][6][7] . In an attempt to minimize blood loss and the need for transfusion, multiple blood managements have been developed to either reduce or salvage perioperative blood loss, including acute normovolemic hemodilution, tourniquet, hypotensive anesthesia, intraoperative blood salvage system, hypotensive anesthesia (HA), and antifibrinolytic agents [8][9][10][11][12][13] .…”

Simultaneous versus staged bilateral total hip arthroplasty: a systematic review and meta-analysis

“…We investigated periprosthetic fracture between the two groups, and contrary to previous studies [ 5 , 7 , 41 , 51 ], the incidence of fracture in simBTHA was higher than in stgBTHA. The unanticipated increased fracture risk in simBTHA can be attributed to the cemented or cementless fixation [ 62 ] and operation time in a single surgery.…”

Pedicle subtraction osteotomy for the corrective surgery of ankylosing spondylitis with thoracolumbar kyphosis: experience with 38 patients

“…Zheng et al [ 23 ] considered that lumbar PSO first might correct the sagittal plane posterior tilt of the pelvis and reduce the risk of prosthesis dislocation after THA. In contrast, Bhan et al [ 24 ], Mou et al [ 25 ], and Joshi et al [ 26 ] suggested that THA should be performed firstly since its improves of the hip mobility and intraoperative positioning of PSO.…”