Total Hip Arthroplasty for Patients Who Have Ankylosing Spondylitis: Is Postoperative Irradiation Required for Prophylaxis of Heterotopic Ossification?

Weng, Hung Kai; Wu, Po Kuei; Chen, Cheng Fong; Chung, Lien Hsiang; Liu, Chien Lin; Chen, Tain Hsiung; Chen, Wei Ming

doi:10.1016/j.arth.2015.04.022

Cited by 9 publications

(8 citation statements)

References 45 publications

(79 reference statements)

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“…No patients who received perioperative prophylaxis developed reankylosis by HO in this study. 248 Although radiation therapy has been proven effective for preventing HO, another retrospective study including 129 hips of 91 Asian AS patients conducted by Weng et al 263 showed no significant difference between the postoperative single-fraction radiotherapy group and the control group ( P = 0.210), suggesting that postoperative radiation may not be necessary in Asian patients.…”

Section: Treatments For Asmentioning

confidence: 99%

Ankylosing spondylitis: etiology, pathogenesis, and treatments

et al. 2019

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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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Section: Treatments For Asmentioning

confidence: 99%

Ankylosing spondylitis: etiology, pathogenesis, and treatments

et al. 2019

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“…Commonly, prophylaxis of HO has mainly been performed with the administration of nonsteroidal anti‐inflammatory drugs (NSAIDs) and radiation therapy. However, we did not use radiation therapy for prophylaxis routinely because its necessity is still controversial 13 , 43 . Two patients complained of mild soreness in their hips during weight‐bearing, with one on both sides and the other on the left side, and one patient complained of moderate pain in the bilateral hips while squatting.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

Orthopaedic Surgery

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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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“…Mild heterotopic ossification was noted in 3 patients (6 hips) (Brooke I and II), and hip activity was not affected. The postoperative irradiation is effective in preventing the occurrence of heterotopic ossification after THA in patients with AS [24].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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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Total Hip Arthroplasty for Patients Who Have Ankylosing Spondylitis: Is Postoperative Irradiation Required for Prophylaxis of Heterotopic Ossification?

Cited by 9 publications

References 45 publications

Ankylosing spondylitis: etiology, pathogenesis, and treatments

Ankylosing spondylitis: etiology, pathogenesis, and treatments

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

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

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