Does the Femoral Head Size Influence Outcomes After Uncemented Total Hip Arthroplasty for Fused Hips? A Prospective Study in Ankylosing Spondylitis



Uncemented total hip arthroplasty (THA) with large size femoral heads have shown greater advantage with good stability, range of motion and decreased dislocation rate in ankylosing spondylitis (AS). Meticulous planning is needed to address the unique surgical challenges in such patients with fused hip and spinal deformity.

Materials and Methods

Thirty fivefused hip joints in twenty-five AS patients who underwent uncemented THA (April 2014 to December 2016) were included in our prospective study and were followed up for a minimum period of 36 months. Pain relief, functional improvement and patient satisfaction were statistically assessed using “Visual Analogue Score” (VAS), “Harris Hip Score” (HHS) and “AJRI 10-Point Satisfaction Score” (A10PSS), respectively.


The overall mean preoperative VAS improved from 6.9 ± 1.5 to 1.5 ± 1, HHS improved from 50.0 ± 12 to 88.4 ± 7.8 and A10PSS improved from 2.2 ± 1.2 to 7.6 ± 0.8. Our study results were significant with zero dislocation and good functional score in comparison to the other available studies in literature. First subdivision study in AS patients with bilateral THA performed better than unilateral THA. Second subdivision study showed no significant statistical difference in terms of VAS, HHS, A10PSS and dislocation rate in relation to femoral head size between 32 mm, 36 mm and 40 mm.


Uncemented THA with large size femoral head equal or greater than 32 mm provides better stability and good functional outcome with less dislocation rate in comparison to older studies of literature with femoral head size less than 32 mm.

Level of Evidence

A Level II study. (Data collected from the ongoing prospective study) (

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Dr. Palanivel C, Professor, SPM Department, JIPMER, Puducherry.

Miss. Lavanya Chandrasekar Physician Assistant, Asian Joint Reconstruction Institute @ SIMS Hospitals, Chennai, Tamil Nadu, India.


No specific financial support was received for this study.

Author information




KK: manuscript writing, operating surgeon; SP: statistics workup, manuscript edit; AKPS: data collection, operating surgeon; SP: chief operating surgeon; VCB: chief operating surgeon.

Corresponding author

Correspondence to Kalaivanan Kanniyan.

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The study was approved by SIMS Institutional Review Board.

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Informed consent from patients was obtained.

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Kanniyan, K., Patil, S., Kumar, P.S.A. et al. Does the Femoral Head Size Influence Outcomes After Uncemented Total Hip Arthroplasty for Fused Hips? A Prospective Study in Ankylosing Spondylitis. JOIO (2020).

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  • Ankylosing spondylitis
  • Fused hip joint
  • Femoral head size
  • Dislocation
  • Uncemented total hip arthroplasty
  • Visual analog score
  • Harris hip score
  • AJRI 10-point satisfaction score
  • Transverse acetabular ligament
  • Spinal deformity